Organization of primary medical care for patients with osteoporosis

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Abstract

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

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About the authors

Elena N. Gladkova

North-Western State Medical University named after I.I. Mechnikov; Clinical Rheumatological Hospital No. 25

Author for correspondence.
Email: gen4605@mail.ru
ORCID iD: 0000-0002-6689-6941
SPIN-code: 6535-4153

MD, Cand. Sci. (Med.), Assistant Lecturer

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

References

  1. Curtis EM, Harvey NC, Cooper C. The burden of osteoporosis. In: Harvey NC, Cooper C (eds). Osteoporosis: a lifecourse epidemiology approach to skeletal health. New-York: CRC Press; 2018:1–20. doi: 10.1201/9781351234627
  2. Global report on ageism. Geneva: WHO; 2021. Licence: CC BY-NC-SA 3.0 IGO.
  3. United Nations, Department of Economic and Social Affairs, Population Division (2017) World population prospects: the 2017 revision, DVD Edition. [Internet]. Available from: https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html. Accessed: May 15, 2020.
  4. Lesnyak O, Bilezikian JP, Zakroyeva A, et al. Report on the audit on burden of osteoporosis in eight countries of the Eurasian Region: Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan. Arch Osteoporos. 2020;15(1):175. doi: 10.1007/s11657-020-00836-y
  5. Dobrovolskaya OV, Toroptsova NV, Lesnyak OM. Economic aspects of complicated osteoporosis: the cost of treatment in the first year after fracture. Modern Rheumatology Journal. 2016;10(3):29–34. (In Russ.). doi: 10.14412/1996-7012-2016-3-29-34
  6. Reid IR. A broader strategy for osteoporosis interventions. Nat Rev Endocrinol. 2020;16(6):333–339. doi: 10.1038/s41574-020-0339-7
  7. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359–2381. doi: 10.1007/s00198-014-2794-2
  8. Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57. doi: 10.1007/s0019 8-012-2074-y
  9. Lekamwasam S, Adachi JD, Agnusdei D, et al. A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int. 2012;23(9):2257–2276. doi: 10.1007/s0019 8-012-1958-1
  10. Lekamwasam S, Adachi JD, Agnusdei D, et al. An appendix to the 2012 IOF-ECTS guidelines for the management of glucocorticoid-induced osteoporosis. Arch Osteoporos. 2012;7:25–30. doi: 10.1007/s1165 7-012-0070-7
  11. Compston J, Cooper A, Cooper C, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2012;12(1):43. doi: 10.1007/s11657-017-0324-5
  12. Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3–44. doi: 10.1007/s00198-018-4704-5
  13. El-Hajj Fuleihan G, Chakhtoura M, Cauley JA, Chamoun N. Worldwide fracture prediction. J Clin Densitom. 2017;20(3):397–424. doi: 10.1016/j.jocd.2017.06.008
  14. National Osteoporosis Guideline Group. NOGG 2017: clinical guideline for the prevention and treatment of osteoporosis [Internet]. Available from: https://www.sheffield.ac.uk/NOGG/NOGG%20Guideline%202017.pdf. Accessed: May 30, 2021.
  15. FRAX. Fracture Risk Assessment Tool [Internet]. Available from: https://www.sheffield.ac.uk/FRAX/index.aspx?lang=rs. Accessed: May 30, 2021.
  16. Leslie WD, Lix LM, Binkley N. Comparison of screening tools for optimizing fracture prevention in Canada. Arch Osteoporos. 2020;15(1):170. doi: 10.1007/s11657-020-00846-w
  17. Shepstone L, Lenaghan E, Cooper C, et al. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018;391(10122):741–747. doi: 10.1016/s0140-6736(17)32640-5
  18. Shepstone L, Fordham R, Lenaghan E, et al. A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of screening older women for the prevention of fractures: rationale, design and methods for the SCOOP study. Osteoporos Int. 2012; 23(10):2507–2515. doi: 10.1007/s00198-011-1876-7
  19. McCloskey E, Johansson H, Harvey NC, et al. Management of patients with high baseline hip fracture risk by FRAX reduces hip fractures – a post hoc analysis of the SCOOP study. J Bone Miner Res. 2018;33(6):1020–1026. doi: 10.1002/jbmr.3411
  20. Turner DA, Khioe RFS, Shepstone L, et al. The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: economic evaluation of the SCOOP study. J Bone Miner Res. 2018;33(5):845–851. doi: 10.1002/jbmr.3381
  21. Rubin KH, Rothmann MJ, Holmberg T, et al. Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporos Int. 2018;29(3):567–578. doi: 10.1007/s00198-017-4326-3
  22. Merlijn T, Swart KM, van Schoor NM, et al. The effect of a screening and treatment program for the prevention of fractures in older women: A randomized pragmatic trial. J Bone Miner Res. 2019;34(11):1993–2000. doi: 10.1002/jbmr.3815
  23. Merlijn T, Swart KMA, van der Horst HE, et al. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int. 2020;31(2):251–257. doi: 10.1007/s00198-019-05226-w
  24. Söreskog E, Borgström F, Shepstone L, et al. Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study. Osteoporos Int. 2020;31(8):1499–1506. doi: 10.1007/s00198-020-05372-6
  25. Kwok TCY, Law SW, Leung EMF, et al. Hip fractures are preventable: a proposal for osteoporosis screening and fall prevention in older people. Hong Kong Med J. 2020;26(3):227–235. doi: 10.12809/hkmj198337
  26. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35(2):375–382. doi: 10.1016/j.bone.2004.03.024
  27. Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15(4):721–739. doi: 10.1359/jbmr.2000.15.4.721
  28. Kochish AYu, Lesnyak OM, Ivanov SN, Silidi IYu. Pervyi opyt organizatsii v Sankt-Peterburge vtorichnoi profilaktiki povtornykh osteoporoticheskikh perelomov kostei v ramkakh programmy “PrometeI” Rossiiskoi assotsiatsii po osteoporozu. Farmateka. 2014;(10–2):12–17. (In Russ.)
  29. Prikaz Ministerstva zdravookhraneniya RF ot 29 marta 2019 g. No. 173 “Ob utverzhdenii poryadka provedeniya dispansernogo nablyudeniya za vzroslymI”. (In Russ.)
  30. Harrington JT. Dilemmas in providing osteoporosis care for fragility fracture patients. US Musculoskeletal Review-Touch Briefings. 2006;2:64–65. [Internet]. Available from: https://www.researchgate.net/publication/313102503_Dilemmas_in_providing_osteoporosis_care_for_fragility_fracture_patients. Accessed: May 30, 2021.
  31. Akesson K, Marsh D, Mitchell PJ, et al. Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24(8):2135–2152. doi: 10.1007/s00198-013-2348-z
  32. Eisman JA, Bogoch ER, Dell R, et al. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res. 2012;27(10):2039–2046. doi: 10.1002/jbmr.1698
  33. Boudou L, Gerbay B, Chopin F, et al. Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int. 2011;22(7):2099–2106. doi: 10.1007/s00198-011-1638-6
  34. Mitchell PJ. Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep. 2013;11(1):52–60. doi: 10.1007/s11914-012-0130-3
  35. Drew S, Judge A, Cooper C, et al. Secondary prevention of fractures after hip fracture: a qualitative study of effective service delivery. Osteoporos Int. 2016;27(5):1719–1727. DOI: 10.1007/ s00198-015-3452-z
  36. Mitchell P, Akesson K, Chandran M, et al. Implementation of models of care for secondary osteoporotic fracture prevention and orthogeriatric models of care for osteoporotic hip fracture. Best Pract Res Clin Rheumatol. 2016;30(3):536–558. doi: 10.1016/j.berh.2016.09.008
  37. Hawley S, Javaid MK, Prieto-Alhambra D, et al. Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age Ageing. 2016;45(2):236–242. doi: 10.1093/ageing/afv204
  38. Harvey NC, McCloskey EV, Mitchell PJ, et al. Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int. 2017;28(5):1507–1529. doi: 10.1007/s00198-016-3894-y
  39. Capture the Fracture [Internet]. Available from: https://www.capturethefracture.org. Accessed: May 30, 2021.
  40. Belova KYu, Ershova OB. Organizatsiya meditsinskoi pomoshchi patsientam s tyazhelym osteoporozom. Krasnoyarsk; 2016. (In Russ.)
  41. Yeam CT, Chia S, Tan HCC, et al. A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporos Int. 2018;29(12):2623–2637. doi: 10.1007/s00198-018-4759-3
  42. Toroptsova NV, Nikitinskaya OA, Dobrovolskaya OV. Treatment adherence in patients with osteoporosis in daily clinical practice. Scientific and Practical Rheumatology. 2014;52(3):336–341. (In Russ.). doi: 10.14412/1995-4484-2014-336-341
  43. Lesnyak OM, Baranova IA, Belova KYu, et al. Osteoporosis in Russian Federation: Epidemiology, socio-medical and economical aspects (review). Traumatology and Orthopedics of Russia. 2018;24(1):155–168. (In Russ.). doi: 10.21823/2311-2905-2018-24-1-155-168
  44. Hitz MF, Arup S, Holm JP, et al. Outcome of osteoporosis evaluation, treatment, and follow-up in patients referred to a specialized outpatient clinic compared to patients in care of general practitioners. Arch Osteoporos. 2020;15(1):97. doi: 10.1007/s11657-020-00774-9
  45. Pepe J, Cipriani C, Cecchetti V, et al. Patients’ reasons for adhering to long-term alendronate therapy. Osteoporos Int. 2019;30(8):1627–1634. doi: 10.1007/s00198-019-05010-w
  46. Mazurov VI, Lesnyak OM, Belova KYu, et al. Algorithm for selection of drug for osteoporosis treatment in primary care and in organization of provision with medicinal products of citizens eligible for state social assistance. Review of the literature and position of Russian association on osteoporosis expert council. The Russian Journal of Preventive Medicine. 2019;22(1):57–65. doi: 10.17116/profmed20192201157

Copyright (c) 2021 Gladkova E.N.

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