Fracture Prevention

Secondary fracture prevention has become an integral component of the fracture care pathway in many orthopedic units worldwide (1). The goals of fracture prevention programs are to mitigate the risk of future fractures (2) with the attendant of high mortality (3), loss of independence and reduced quality of life (4) and other socioeconomic-related consequences (5).

The Fracture Prevention Program at St. Michael’s Hospital, the first in Canada, is a co-ordinator-based multidisciplinary quality assurance program which facilitates the identification, education, bone health assessment and appropriate treatment of people who have sustained a fragility (low trauma) fracture in order to prevent future fractures.


Core Researchers

Osteoporosis Exemplary Care Program Coordinator

  • Victoria Elliot-Gibson, MS

Email:  elliotv@smh.ca

Phone:  416-864-6060  Ext. 77032

 

 

Featured Study

Osteoporosis Screening for patients who had a fragility fracture in Ontario

The co-ordinator identifies men, aged 50 years and older, and women, aged 40 years and older, who have sustained a low-trauma fracture of the distal radius (wrist), proximal humerus (shoulder), proximal femur (hip) and vertebrae (spine) in both the outpatient Fracture Clinic and inpatients on the orthopedic unit. Fracture Clinic patients are:

  • educated on fracture prevention and nutrition
  • referred for a bone mineral density test, if indicated

referred back to their family physician or to a specialist at St. Michael’s Hospital for a complete bone health assessment and implementation of prescription treatment to lower their future fracture risk, if indicated

Inpatients are assessed by either Geriatrics or Rheumatology for a bone health assessment, and if follow-up is required, the co-ordinator arranges a bone-mineral density test and an outpatient appointment at the Post Fracture Osteoporosis Clinic.


Quality Assurance

In addition to the clinical program, there is a quality assurance/improvement component of the program. Patients are provided with a quality assurance questionnaire, which is voluntary to complete, that asks about fracture history, family history of fracture, risk factors for fracture, prior bone health testing and treatment, as well as perceptions and knowledge of fracture and osteoporosis. Patients agreeing to follow up are also provided with a six-month, follow-up questionnaire that asks about bone health testing and treatment done within the six months, as well as knowledge and perception of fracture and osteoporosis. This information allows us to continually review the success of our program and to make necessary program modifications.

Our Sponsors

This program has received funding from:

  • Clifford Martin
  • Helen McCrea Peacock Foundation
  • Warner Chilcott
  • Merck Frosst Canada Inc.
  • Amgen Canada
  • Novartis Canada Ltd.

References

(1) Sale JE, Beaton D, Posen J, Elliot-Gibson V, Bogoch E. Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients.Osteoporos Int. 2011;22(7):2067-82.

Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int. 2013;24(2):393-406

Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E; ASBMR Task Force on Secondary Fracture Prevention. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention.JBone Miner Res. 2012;27(10):2039-46

Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C; IOF Fracture Working Group. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24(8):2135-52.

(2) Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A. A meta-analysis of previous fracture and subsequent fracture risk.Bone.2004;35(2):375-82.

Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. 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):721-39.

Melton LJ 3rd, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL. Vertebral fractures predict subsequent fractures.Osteoporos Int. 1999;10(3):214-21.

Schrøder HM, Petersen KK, Erlandsen M. Occurrence and incidence of the second hip fracture.ClinOrthopRelat Res. 1993 Apr;(289):166-9.

(3) Ioannidis G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L, Kennedy CC, Prior JC, Olszynski WP, Davison KS, Goltzman D, Thabane L, Gafni A, Papadimitropoulos EA, Brown JP, Josse RG, Hanley DA, Adachi JD. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study.CMAJ. 2009 Sep 1;181(5):265-71

Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years.Injury. 2008 Oct;39(10):1157-63

Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture.Osteoporos Int. 2004; 15(11):897-902

Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures.Osteoporos Int. 2000;11(7):556-61.

(4) Beaupre LA, Jones CA, Johnston DW, Wilson DM, Majumdar SR. Recovery of function following a hip fracture in geriatric ambulatory persons living in nursing homes: prospective cohort study. J Am Geriatr Soc. 2012;60(7):1268-73.

Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos EA, Hopman W, Poliquin S, Prior JC, Hanley DA, Olszynski WP, Anastassiades T, Brown JP, Murray T, Jackson SA, Tenenhouse A; Canadian Multicentre Osteoporosis Study (CaMos) Research Group. The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada.Osteoporos Int. 2001;12(11):903-8.

Begerow B, Pfeifer M, Pospeschill M, Scholz M, Schlotthauer T, Lazarescu A, Pollaehne W, Minne HW. Time since vertebral fracture: an important variable concerning quality of life in patients with postmenopausal osteoporosis.Osteoporos Int. 1999;10(1):26-33

(5) W. D. Leslie & L. M. Lix& G. S. Finlayson & C. J. Metge& S. N. Morin & S. R. Majumdar. Direct healthcare costs for 5 years post-fracture in Canada. A long-term population-based assessment.Osteoporos Int (2013) 24:1697–1705

Nikitovic M, Wodchis WP, Krahn MD, Cadarette SM. Direct health-care costs attributed to hip fractures among seniors: a matched cohort study.Osteoporos Int. 2013;24(2):659-69

Hopkins RB, Tarride JE, Leslie WD, Metge C, Lix LM, Morin S, Finlayson G, Azimaee M, Pullenayegum E, Goeree R, Adachi JD, Papaioannou A, Thabane L. Estimating the excess costs for patients with incident fractures, prevalent fractures, and non-fracture osteoporosis.Osteoporos Int. 2013;24(2):581-93.

Bessette L, Jean S, Lapointe-Garant MP, Belzile EL, Davison KS, Ste-Marie LG, Brown JP. Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women. Osteoporos Int. 2012 ;23(6):1757-68.

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