Osuna Patricia Mejia, Ruppe Mary D, Tabatabai Laila S
Endocr Pract. 2017 Feb;23(2):199-206. doi: 10.4158/EP161433.RA. Epub 2016 Nov 16.
A well-recognized gap exists between evidence-based recommendations for post-fracture care and actual clinical practice, demonstrated by the high percentage of fragility fracture patients who are neither diagnosed nor treated for osteoporosis. Our purpose is to review fracture liaison service (FLS) models and to evaluate national and international experiences in secondary fracture prevention.
We performed a systematic search of publication databases (MEDLINE, SCOPUS) and included randomized controlled trials, meta-analyses, and review articles using the following keywords: Fracture liaison services, Secondary prevention of fracture, Post-fracture healthcare gap, and fragility fractures. References were included from 2001-2015. We subsequently performed reference searches of retrieved articles and available literature was reviewed.
The efficacy of secondary fracture prevention programs correlates strongly with their intensity. Type A FLS Models are most successful in initiating diagnostic and treatment plans for fragility fracture patients. Adoption of FLS programs improves care by lowering mortality and refracture rates while also lowering healthcare costs. The quality of evidence supporting associations between FLS programs and improved outcomes was moderately strong due to the availability of longitudinal data from nationalized health systems.
As our population ages and challenges to the healthcare system loom ever larger, it is imperative that we fund and champion fracture liaison services. The fracture liaison service has recently emerged as a novel clinical approach that uses coordinated, multidisciplinary care to improve post-fracture outcomes and reduce recurrent fractures. These programs are simple, targeted, high-yield and have the potential to protect our most vulnerable patients.
DXA = dual-energy x-ray absorptiometry FLS = fracture liaison service NCQA = National Committee of Quality Assurance NHS = National Health Service PCP = primary care physician PQRS = Physician Quality Reporting System QCDR = Qualified Clinical Data Registry.
骨折后护理的循证建议与实际临床实践之间存在着一个公认的差距，这一点从很大比例的脆性骨折患者未被诊断出骨质疏松症且未接受治疗即可看出。我们的目的是回顾骨折联络服务（FLS）模式，并评估国内外二级骨折预防的经验。
我们对出版物数据库（MEDLINE、SCOPUS）进行了系统检索，纳入了使用以下关键词的随机对照试验、荟萃分析和综述文章：骨折联络服务、骨折的二级预防、骨折后医疗差距和脆性骨折。纳入了2001年至2015年的参考文献。随后，我们对检索到的文章进行了参考文献检索，并对现有文献进行了综述。
二级骨折预防项目的疗效与其强度密切相关。A型FLS模式在启动脆性骨折患者的诊断和治疗计划方面最为成功。采用FLS项目可通过降低死亡率和再骨折率同时降低医疗成本来改善护理。由于有来自国家卫生系统的纵向数据，支持FLS项目与改善结局之间关联的证据质量中等强度。
随着我们的人口老龄化以及医疗系统面临的挑战日益严峻，为骨折联络服务提供资金并大力支持至关重要。骨折联络服务最近已成为一种新颖的临床方法，它采用协调的多学科护理来改善骨折后结局并减少复发性骨折。这些项目简单、有针对性、高效益，并且有潜力保护我们最脆弱的患者。
DXA = 双能X线吸收法；FLS = 骨折联络服务；NCQA = 国家质量保证委员会；NHS = 国民保健制度；PCP = 初级保健医生；PQRS = 医生质量报告系统；QCDR = 合格临床数据登记处
