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The first reported fracture liaison service (FLS) for vertebral fractures in China: is muscle the missing gap?

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Abstract

Summary

Fracture liaison services (FLS) have been implemented worldwide, but we present one of the first reported experiences in China. Only 1 out of 226 patients had a secondary fracture within 1 year. This serves as a platform to improving solutions and decreasing imminent fractures for future use nationwide in China.

Introduction

Fracture liaison services (FLS) have been implemented worldwide but we present one of the first reported experiences in China. Vertebral fragility fracture is one of the earliest fracture to occur. The objective of this study was to implement a dedicated fracture service to decrease imminent fractures for future use nationwide in China.

Methods

Patients 50 years or older with a recent vertebral compression fracture were recruited. All patients were offered investigation with DXA scan and blood taking. Treatment was provided with calcium and vitamin D supplements and denosumab injections. The primary outcome was the imminent fracture rate or the re-fracture rate occurring within 2 years of the initial one. Secondary outcomes were bone mineral density (BMD), treatment initiation, adherence to drug, compliance to follow-up, falls, mortality, pain, quality of life, pain-related disability with Roland-Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI).

Results

Two hundred twenty-six patients (n = 226) were analyzed. 0.4% (n = 1) had an imminent fracture within 2 years. 11.1% (n = 25) had a fall within 2 years, in which 1 resulted in a major osteoporotic fracture. 7.1% died (n = 16) within the 2-year time period. 97.8% (n = 221) underwent BMD investigation with an initial DXA scan. One hundred percent (n = 226) had treatment initiation and were prescribed with Denosumab injections. 89.8% (n = 203) were compliant and showed complete adherence to drug therapy over the 2 years. Pain, quality of life, and disability were significantly improved.

Conclusion

This is the first reported fracture liaison service for vertebral fracture patients reported in China. Future FLS should incorporate muscle and sarcopenic assessments as a routine, and also research on novel interventions in this area would significantly improve patient outcomes.

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References

  1. Rachner TD, Khosla S, Hofbauer LC (2011) Osteoporosis: now and the future. Lancet 377(9773):1276–1287

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Haczynski J, Jakimiuk A (2001) Vertebral fractures: a hidden problem of osteoporosis. Med Sci Monit 7(5):1108–1117

    CAS  PubMed  Google Scholar 

  3. Cui L, Chen L, Xia W, Jiang Y, Huang W, Wang W et al (2017) Vertebral fracture in postmenopausal Chinese women: a population-based study. Osteoporos Int 28(9):2583–2590

    CAS  PubMed  Google Scholar 

  4. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42

    CAS  PubMed  Google Scholar 

  5. Song X, Shi N, Badamgarav E, Kallich J, Varker H, Lenhart G et al (2011) Cost burden of second fracture in the US health system. Bone 48(4):828–836

    PubMed  Google Scholar 

  6. Kanis JA, Cooper C, Rizzoli R, Abrahamsen B, Al-Daghri NM, Brandi ML et al (2017) Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int 28(7):2023–2034

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Wong RMY, Ho WT, Wai LS, Li W, Chau WW, Chow KS et al (2019) Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies. Arch Osteoporos 14(1):104

    PubMed  Google Scholar 

  8. Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–127

    PubMed  PubMed Central  Google Scholar 

  9. Huntjens KM, van Geel TA, van den Bergh JP, van Helden S, Willems P, Winkens B et al (2014) Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am 96(4):e29

    PubMed  Google Scholar 

  10. Wu CH, Kao IJ, Hung WC, Lin SC, Liu HC, Hsieh MH et al (2018) Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature. Osteoporos Int 29(6):1227–1242

    PubMed  Google Scholar 

  11. Wu CH, Tu ST, Chang YF, Chan DC, Chien JT, Lin CH et al (2018) Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone 111:92–100

    PubMed  Google Scholar 

  12. Wong RMY, Law SW, Lee KB, Chow SKH, Cheung WH (2019) Secondary prevention of fragility fractures: instrumental role of a fracture liaison service to tackle the risk of imminent fracture. Hong Kong Med J 25(3):235–242

    CAS  PubMed  Google Scholar 

  13. McGuire R (2011) AAOS Clinical Practice Guideline: the treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg 19(3):183–184

    PubMed  Google Scholar 

  14. McCarthy J, Davis A (2016) Diagnosis and management of vertebral compression fractures. Am Fam Physician 94(1):44–50

    PubMed  Google Scholar 

  15. Esses SI, McGuire R, Jenkins J, Finkelstein J, Woodard E, Watters WC 3rd et al (2011) American Academy of Orthopaedic Surgeons clinical practice guideline on: the treatment of osteoporotic spinal compression fractures. J Bone Joint Surg Am 93(20):1934–1936

    PubMed  Google Scholar 

  16. European Prospective Osteoporosis Study G, Felsenberg D, Silman AJ, Lunt M, Armbrecht G, Ismail AA et al (2002) Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17(4):716–24

    Google Scholar 

  17. Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A et al (2020) American Association Of Clinical Endocrinologists/American College Of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis- 2020 UPDATE. Endocr Pract 26(5):564–570

    PubMed  Google Scholar 

  18. Freemantle N, Satram-Hoang S, Tang ET, Kaur P, Macarios D, Siddhanti S et al (2012) Final results of the DAPS (Denosumab Adherence Preference Satisfaction) study: a 24-month, randomized, crossover comparison with alendronate in postmenopausal women. Osteoporos Int 23(1):317–326

    CAS  PubMed  Google Scholar 

  19. Cheung NT, Fung KW, Wong KC, Cheung A, Cheung J, Ho W et al (2001) Medical informatics–the state of the art in the Hospital Authority. Int J Med Inform 62(2–3):113–119

    CAS  PubMed  Google Scholar 

  20. Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J 15 Suppl 1:S17-24

    PubMed  Google Scholar 

  21. Huo T, Guo Y, Shenkman E, Muller K (2018) Assessing the reliability of the short form 12 (SF-12) health survey in adults with mental health conditions: a report from the wellness incentive and navigation (WIN) study. Health Qual Life Outcomes 16(1):34

    PubMed  PubMed Central  Google Scholar 

  22. Lim HS, Chen PP, Wong TC, Gin T, Wong E, Chan IS et al (2007) Validation of the Chinese version of pain self-efficacy questionnaire. Anesth Analg 104(4):918–923

    PubMed  Google Scholar 

  23. Chow JH, Chan CC (2005) Validation of the Chinese version of the Oswestry Disability Index. Work 25(4):307–314

    PubMed  Google Scholar 

  24. Senay A, Perreault S, Delisle J, Morin SN, Fernandes JC (2020) Performance of a fracture liaison service in an orthopaedic setting: a report of key indicators and improvement of longitudinal outcomes. J Bone Joint Surg Am 102(6):486–494

    PubMed  Google Scholar 

  25. Kirk B, Zanker J, Duque G (2020) Osteosarcopenia: epidemiology, diagnosis, and treatment-facts and numbers. J Cachexia Sarcopenia Muscle 11(3):609–618

    PubMed  PubMed Central  Google Scholar 

  26. Noordin S, Allana S, Masri BA (2018) Establishing a hospital based fracture liaison service to prevent secondary insufficiency fractures. Int J Surg 54(Pt B):328–332

    PubMed  Google Scholar 

  27. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR et al (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24(2):393–406

    CAS  PubMed  Google Scholar 

  28. Lau E, Ong K, Kurtz S, Schmier J, Edidin A (2008) Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. J Bone Joint Surg Am 90(7):1479–1486

    PubMed  Google Scholar 

  29. Jarvinen TL, Sievanen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336(7636):124–126

    PubMed  PubMed Central  Google Scholar 

  30. van der Jagt-Willems HC, de Groot MH, van Campen JP, Lamoth CJ, Lems WF (2015) Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study. BMC Geriatr 15:34

    PubMed  PubMed Central  Google Scholar 

  31. Wong RMY, Wong H, Zhang N, Chow SKH, Chau WW, Wang J et al (2019) The relationship between sarcopenia and fragility fracture-a systematic review. Osteoporos Int 30(3):541–553

    CAS  PubMed  Google Scholar 

  32. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–423

    PubMed  PubMed Central  Google Scholar 

  33. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48(4):601

    PubMed  PubMed Central  Google Scholar 

  34. Liu C, Cheung WH, Li J, Chow SK, Yu J, Wong SH, Ip M, Sung JJY, Wong RMY (2021) Understanding the gut microbiota and sarcopenia: a systematic review. J Cachexia Sarcopenia Muscle. https://doi.org/10.1002/jcsm.12784

  35. Szulc P, Feyt C, Chapurlat R (2016) High risk of fall, poor physical function, and low grip strength in men with fracture-the STRAMBO study. J Cachexia Sarcopenia Muscle 7(3):299–311

    PubMed  Google Scholar 

  36. Ong T, Sahota O, Gladman JRF (2020) The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 31(2):363–370

    CAS  PubMed  Google Scholar 

  37. Kim HJ, Park S, Park SH, Park J, Chang BS, Lee CK et al (2018) Prevalence of frailty in patients with osteoporotic vertebral compression fracture and its association with numbers of fractures. Yonsei Med J 59(2):317–324

    PubMed  Google Scholar 

  38. Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia. Lancet 393(10191):2636–2646

    PubMed  Google Scholar 

  39. Ip TP, Cheung SK, Cheung TC, Choi TC, Chow SL, Ho YY et al (2013) The Osteoporosis Society of Hong Kong (OSHK): 2013 OSHK guideline for clinical management of postmenopausal osteoporosis in Hong Kong. Hong Kong Med J 19 Suppl 2:1–40

    PubMed  Google Scholar 

  40. Roux C, Briot K (2017) Imminent fracture risk. Osteoporos Int 28(6):1765–1769

    CAS  PubMed  Google Scholar 

  41. Maraka S, Kennel KA (2015) Bisphosphonates for the prevention and treatment of osteoporosis. BMJ 351:h3783

    PubMed  Google Scholar 

  42. Imaz I, Zegarra P, Gonzalez-Enriquez J, Rubio B, Alcazar R, Amate JM (2010) Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis. Osteoporos Int 21(11):1943–1951

    CAS  PubMed  Google Scholar 

  43. Cheng LI, Durden E, Limone B, Radbill L, Juneau PL, Spangler L et al (2015) Persistance and compliance with osteroporosis therapies among women in a commercially insured population in the United States. J Manag Care Spec Pharm 21(9):824–33, 33a

    PubMed  Google Scholar 

  44. Kelly OJ, Gilman JC, Boschiero D, Ilich JZ (2019) Osteosarcopenic obesity: current knowledge, revised identification criteria and treatment principles. Nutrients 11(4):747. https://doi.org/10.3390/nu11040747

    Article  CAS  PubMed Central  Google Scholar 

  45. Suzuki N, Ogikubo O, Hansson T (2010) Previous vertebral compression fractures add to the deterioration of the disability and quality of life after an acute compression fracture. Eur Spine J 19(4):567–574

    PubMed  Google Scholar 

  46. Lam ET, Lam CL, Fong DY, Huang WW (2013) Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese? J Eval Clin Pract 19(1):200–208

    PubMed  Google Scholar 

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Funding

The study is funded by the General Research Fund Early Career Scheme, HKSAR Research Grant Council (Ref: 24108519).

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Authors and Affiliations

  1. Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China

    Ronald Man Yeung Wong, Shaau Yiu Ko, Wai-Wang Chau, Linus Chee Yeen Lee, Simon Kwoon Ho Chow, Wing Hoi Cheung & Sheung Wai Law

  2. Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China

    Ronald Man Yeung Wong & Sheung Wai Law

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  1. Ronald Man Yeung Wong
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Correspondence to Wing Hoi Cheung.

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Wong, R.M.Y., Ko, S.Y., Chau, WW. et al. The first reported fracture liaison service (FLS) for vertebral fractures in China: is muscle the missing gap?. Arch Osteoporos 16, 168 (2021). https://doi.org/10.1007/s11657-021-01036-y

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