nach oben

Current Osteoporosis Reports

Erschienen in:

31.10.2019 | Quality of Care in Osteoporosis (S Silverman and J Curtis, Section Editors)

Population-Based Osteoporosis Primary Prevention and Screening for Quality of Care in Osteoporosis, Current Osteoporosis Reports

verfasst von: William D. Leslie, Carolyn J. Crandall

Erschienen in: Current Osteoporosis Reports | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Despite the high prevalence and impact of osteoporosis, screening and treatment rates remain low, with few women age 65 years and older utilizing osteoporosis screening for primary prevention.

Recent Findings

This review examines opportunities and challenges related to primary prevention and screening for osteoporosis at the population level. Strategies on how to identify individuals at high fracture risk and target them for treatment have lagged far behind other developments in the osteoporosis field. Most osteoporosis quality improvement strategies have focused on patients with recent or prior fracture (secondary prevention), with limited attention to individuals without prior fracture. For populations without prior fracture, the only quality improvement strategy for which meta-analysis demonstrated significant improvement in osteoporosis care was patient self-scheduling of DXA plus education

Summary

Much more work is needed to develop and validate effective primary screening and prevention strategies and translate these into high-quality guidelines.

Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364–76. https://doi.org/10.1016/s0140-6736(18)32112-3.CrossRefPubMed

Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20(7):1185–94. https://doi.org/10.1359/JBMR.050304.CrossRefPubMed

Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. 2007;18(8):1033–46. https://doi.org/10.1007/s00198-007-0343-y.CrossRefPubMed

Murad MH, Drake MT, Mullan RJ, Mauck KF, Stuart LM, Lane MA, et al. Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis. J Clin Endocrinol Metab. 2012;97(6):1871–80. https://doi.org/10.1210/jc.2011-3060.CrossRefPubMed

Saito T, Sterbenz JM, Malay S, Zhong L, MacEachern MP, Chung KC. Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int. 2017;28(12):3289–300. https://doi.org/10.1007/s00198-017-4175-0.CrossRefPubMed

Laliberte MC, Perreault S, Jouini G, Shea BJ, Lalonde L. Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis. Osteoporos Int. 2011;22(11):2743–68. https://doi.org/10.1007/s00198-011-1557-6.CrossRefPubMed

Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, et al. Addressing the crisis in the treatment of osteoporosis: a path forward. J Bone Miner Res. 2016. https://doi.org/10.1002/jbmr.3074.CrossRefPubMed

Little EA, Eccles MP. A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis. Implement Sci. 2010;5:80. https://doi.org/10.1186/1748-5908-5-80.CrossRefPubMedPubMedCentral

Mitchell PJ. Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep. 2013;11(1):52–60. https://doi.org/10.1007/s11914-012-0130-3.CrossRefPubMed

10.

Osuna PM, Ruppe MD, Tabatabai LS. Fracture liaison services: multidisciplinary approaches to secondary fracture prevention. Endocr Pract. 2017;23(2):199–206. https://doi.org/10.4158/EP161433.RA.CrossRefPubMed

11.

Warriner AH, Outman RC, Feldstein AC, Roblin DW, Allison JJ, Curtis JR, et al. Effect of self-referral on bone mineral density testing and osteoporosis treatment. Med Care. 2014;52(8):743–50. https://doi.org/10.1097/MLR.0000000000000170.CrossRefPubMedPubMedCentral

12.

• Gillespie CW, Morin PE. Trends and disparities in osteoporosis screening among women in the United States, 2008-2014. Am J Med. 2017;130(3):306–16. https://doi.org/10.1016/j.amjmed.2016.10.018. De-identified administrative claims information for over 100 million Medicare Advantage and commercial enrollees, 2008–1014. Study participants included 1,638,454 women ages 50+ with no prior history of osteoporosis diagnosis, osteoporosis drug use, or hip fracture. Osteoporosis screening rates during the 2-year period were low: 21.1%, 26.5%, and 12.8% among women ages 50–64, 65–79, and 80+ years, respectively. Between 2008 and 2014, utilization among women ages 50–64 years declined 31.4%, changed little among women 65–79, and increased 37.7% among women 80+ years. CrossRefPubMed

13.

Yoshimura M, Moriwaki K, Noto S, Takiguchi T. A model-based cost-effectiveness analysis of osteoporosis screening and treatment strategy for postmenopausal Japanese women. Osteoporos Int. 2017;28(2):643–52. https://doi.org/10.1007/s00198-016-3782-5.CrossRefPubMed

14.

Su Y, Lai FTT, Yip BHK, Leung JCS, Kwok TCY. Cost-effectiveness of osteoporosis screening strategies for hip fracture prevention in older Chinese people: a decision tree modeling study in the Mr. OS and Ms. OS cohort in Hong Kong. Osteoporos Int. 2018. https://doi.org/10.1007/s00198-018-4543-4.CrossRefPubMed

15.

•• Gourlay ML, Overman RA, Fine JP, Crandall CJ, Robbins J, Schousboe JT, et al. Time to clinically relevant fracture risk scores in postmenopausal women. Am J Med. 2017;130(7):862 e15–23. https://doi.org/10.1016/j.amjmed.2017.02.012. Postmenopausal women aged 50–64 years who had low FRAX-predicted fracture risk (major osteoporotic fracture risk < 9.2%) at baseline were highly unlikely to develop a treatment-level FRAX score even after 16 years of follow-up. CrossRef

16.

•• Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, et al. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018;391(10122):741–7. https://doi.org/10.1016/S0140-6736(17)32640-5. Compared with routine care, community-based osteoporosis screening in the UK using age-specific FRAX thresholds did not reduce osteoporosis-related fractures overall but reduced the secondary endpoint of hip fractures by 28%. CrossRefPubMed

17.

• Turner DA, Khioe RFS, Shepstone L, Lenaghan E, Cooper C, Gittoes N, 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. https://doi.org/10.1002/jbmr.3381. In the SCOOP trial of community-based osteoporosis screening versus routine care in the women aged 70–85 years in the UK, the FRAX-based screening strategy was highly cost-effective. CrossRefPubMed

18.

• McCloskey E, Johansson H, Harvey NC, Shepstone L, Lenaghan E, Fordham R, 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. https://doi.org/10.1002/jbmr.3411. In the SCOOP randomized trial of FRAX-based osteoporosis screening versus usual care in older women, the efficacy of the screening intervention in reducing hip fracture risk was not observed in women with the lowest baseline FRAX-predicted hip fracture risk. CrossRefPubMed

19.

•• Rubin KH, Rothmann MJ, Holmberg T, Hoiberg M, Moller S, Barkmann R, 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. 2017. https://doi.org/10.1007/s00198-017-4326-3. The ROSE trial tested a community-based osteoporosis screening intervention versus usual care among women aged 65–80 years in Denmark. Compared with usual care, the FRAX-based screening intervention did not decrease osteoporosis-related fractures, but decreased the secondary outcomes of hip fractures and major osteoporotic fractures. CrossRefPubMed

20.

• Rothmann MJ, Moller S, Holmberg T, Hojberg M, Gram J, Bech M, et al. Non-participation in systematic screening for osteoporosis-the ROSE trial. Osteoporos Int. 2017. https://doi.org/10.1007/s00198-017-4205-y. In the ROSE trial of FRAX-based screening vs. usual care in older women, certain factors were associated with lower likelihood of accepting DXA screening, including higher alcohol consumption, older age, current smoking, and physical impairment. CrossRefPubMed

21.

•• Crandall CJ, Larson J, Manson JE, Cauley JA, LaCroix AZ, Wactawski-Wende J, et al. A comparison of US and Canadian osteoporosis screening and treatment strategies in postmenopausal women. J Bone Miner Res. 2019;34(4):607–15. https://doi.org/10.1002/jbmr.3636. Among postmenopausal women 50–64 years old in the Women’s Health Initiative Study, both the US Preventive Services Task Force and the Canadian osteoporosis screening strategies failed to identify the majority of women who actually experienced major osteoporotic fractures during 10 years of follow-up. Better screening algorithms are needed for women aged 50–64 years. CrossRefPubMed

22.

•• Crandall CJ, Schousboe JT, Morin SN, Lix LM, Leslie W. Performance of FRAX and FRAX-based treatment thresholds in women aged 40 years and older: the Manitoba BMD registry. J Bone Miner Res. 2019;34(8):1419–27. https://doi.org/10.1002/jbmr.3717. For identifying women aged age 40 who experience major osteoporotic fractures during 10 years of follow-up, femoral neck bone mineral density T-score and FRAX-predicted fracture risk used as a continuous measures each predicted fracture risk well. However, thresholds of bone density or FRAX score recommended by treatment guidelines had low sensitivity for identifying women who experienced incident major osteoporotic fractures, suggesting that threshold-based approaches should be reassessed particularly in younger postmenopausal women. CrossRefPubMed

23.

Gourlay ML, Ritter VS, Fine JP, Overman RA, Schousboe JT, Cawthon PM, et al. Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study. Arch Osteoporos. 2017;12(1):91. https://doi.org/10.1007/s11657-017-0389-1.CrossRefPubMedPubMedCentral

24.

• Diem SJ, Peters KW, Gourlay ML, Schousboe JT, Taylor BC, Orwoll ES, et al. Screening for osteoporosis in older men: operating characteristics of proposed strategies for selecting men for BMD testing. J Gen Intern Med. 2017. https://doi.org/10.1007/s11606-017-4153-4. In untreated older men, the Osteoporosis Self-Assessment Tool performed as well as the FRAX tool in identifying osteoporosis while FRAX performed better for identifying men qualifying for NOF guidelines-based treatment. Both strategies reduced the proportion of men referred for BMD testing compared with universal screening. CrossRefPubMedPubMedCentral

25.

Crandall CJ, Larson J, LaCroix A, Cauley JA, LeBoff MS, Li W, et al. Predicting fracture risk in younger postmenopausal women: comparison of the Garvan and FRAX risk calculators in the women’s health initiative study. J Gen Intern Med. 2018. https://doi.org/10.1007/s11606-018-4696-z.CrossRefPubMedPubMedCentral

26.

Colon-Emeric CS, Pieper CF, Van Houtven CH, Grubber JM, Lyles KW, Lafleur J, et al. Limited osteoporosis screening effectiveness due to low treatment rates in a national sample of older men. Mayo Clin Proc. 2018;93(12):1749–59. https://doi.org/10.1016/j.mayocp.2018.06.024.CrossRefPubMed

27.

• Leslie WD, Seeman E, Morin SN, Lix LM, Majumdar SR. The diagnostic threshold for osteoporosis impedes fracture prevention in women at high risk for fracture: a registry-based cohort study. Bone. 2018;114:298–303. https://doi.org/10.1016/j.bone.2018.07.004. "Guidelines are not enough." Among 3735 screened untreated women qualifying for treatment, only half actually initiated treatment. Presence/absence of a BMD T-score in the osteoporotic range was the primary determinant of treatment, even for those with prior vertebral fracture, hip fracture, or multiple fractures. CrossRefPubMed

28.

Lorentzon M, Nilsson AG, Johansson H, Kanis JA, Mellstrom D, Sundh D. Extensive undertreatment of osteoporosis in older Swedish women. Osteoporos Int. 2019;30(6):1297–305. https://doi.org/10.1007/s00198-019-04872-4.CrossRefPubMedPubMedCentral

29.

Wu CH, Kao IJ, Hung WC, Lin SC, Liu HC, Hsieh MH, et al. Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature. Osteoporos Int. 2018;29(6):1227–42. https://doi.org/10.1007/s00198-018-4411-2.CrossRefPubMed

30.

Wu CH, Tu ST, Chang YF, Chan DC, Chien JT, Lin CH, et al. Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone. 2018;111:92–100. https://doi.org/10.1016/j.bone.2018.03.018.CrossRefPubMed

31.

Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR. Recognition of vertebral fracture in a clinical setting. Osteoporos Int. 2000;11(7):577–82. https://doi.org/10.1007/s001980070078.CrossRefPubMed

32.

Barton DW, Behrend CJ, Carmouche JJ. Rates of osteoporosis screening and treatment following vertebral fracture. Spine J. 2018. https://doi.org/10.1016/j.spinee.2018.08.004.CrossRefPubMed

33.

Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158(8):588–95. https://doi.org/10.7326/0003-4819-158-8-201304160-00003.CrossRefPubMedPubMedCentral

34.

Lee SJ, Pickhardt PJ. Opportunistic screening for osteoporosis using body CT scans obtained for other indications: the UW experience. Clin Rev Bone Miner Metab. 2017;15(3):128–37. https://doi.org/10.1007/s12018-017-9235-7.CrossRef

35.

Pickhardt PJ, Lee SJ, Liu J, Yao J, Lay N, Graffy PM, et al. Population-based opportunistic osteoporosis screening: validation of a fully automated CT tool for assessing longitudinal BMD changes. Br J Radiol. 2019;92(1094):20180726. https://doi.org/10.1259/bjr.20180726.CrossRefPubMed

36.

Li YL, Wong KH, Law MW, Fang BX, Lau VW, Vardhanabuti VV, et al. Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population. Arch Osteoporos. 2018;13(1):76. https://doi.org/10.1007/s11657-018-0492-y.CrossRefPubMed

37.

Buckens CF, Dijkhuis G, de Keizer B, Verhaar HJ, de Jong PA. Opportunistic screening for osteoporosis on routine computed tomography? An external validation study. Eur Radiol. 2015;25(7):2074–9. https://doi.org/10.1007/s00330-014-3584-0.CrossRefPubMed

38.

Bar A, Wolf L, Amitai OB, Toledano E, Elnekave E, editors. Compression fractures detection on CT. Medical Imaging 2017: computer-aided diagnosis; 2017: International Society for Optics and Photonics.

39.

Williams ST, Lawrence PT, Miller KL, Crook JL, LaFleur J, Cannon GW, et al. A comparison of electronic and manual fracture risk assessment tools in screening elderly male US veterans at risk for osteoporosis. Osteoporos Int. 2017. https://doi.org/10.1007/s00198-017-4172-3.CrossRefPubMed

40.

Goldshtein I, Ish-Shalom S, Leshno M. Impact of FRAX-based osteoporosis intervention using real world data. Bone. 2017;103:318–24. https://doi.org/10.1016/j.bone.2017.07.027.CrossRefPubMed

41.

Goldshtein I, Gerber Y, Ish-Shalom S, Leshno M. Fracture Risk Assessment with FRAX using real-world data: a population-based cohort from Israel. Am J Epidemiol. 2017. https://doi.org/10.1093/aje/kwx128.CrossRef

42.

Reber KC, Konig HH, Becker C, Rapp K, Buchele G, Machler S, et al. Development of a risk assessment tool for osteoporotic fracture prevention: a claims data approach. Bone. 2018;110:170–6. https://doi.org/10.1016/j.bone.2018.02.002.CrossRefPubMed

43.

Yang S, Leslie WD, Morin SN, Lix LM. Administrative healthcare data applied to fracture risk assessment. Osteoporos Int. 2019;30(3):565–71. https://doi.org/10.1007/s00198-018-4780-6.CrossRefPubMed

44.

•• Rubin KH, Moller S, Holmberg T, Bliddal M, Sondergaard J, Abrahamsen B. A new fracture risk assessment tool (FREM) based on public health registries. J Bone Miner Res. 2018. https://doi.org/10.1002/jbmr.3528. Ambitious derivation and internal validation of FREM—Fracture Risk Evaluation Model—for automated case finding of high-risk individuals of hip or major osteoporotic fractures (MOF) using the population in Denmark aged 45+ years (N = 2,495,339), all hospital diagnoses from 1998 to 2012 and fracture outcomes during 2013. FREM for MOF (38 and 43 risk factors for women and men, respectively) in the validation cohort showed high accuracy (AUC 0.750, 95% CI 0.741, 0.795, and 0.752, 95% CI 0.743, 0.761 for women and men, respectively). FREM for hip fractures included 32 risk factors for both genders and gave AUC 0.874 (95% CI 0.869, 0.879) and 0.851 (95% CI 0.841, 0.861) for women and men. CrossRefPubMed

45.

Negm AM, Ioannidis G, Jantzi M, Bucek J, Giangregorio L, Pickard L, et al. Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents. BMC Geriatr. 2018;18(1):320. https://doi.org/10.1186/s12877-018-1010-1.CrossRefPubMedPubMedCentral

46.

Berry SD, Zullo AR, Lee Y, Mor V, McConeghy KW, Banerjee G, et al. Fracture risk assessment in long-term care (FRAiL): development and validation of a prediction model. J Gerontol A Biol Sci Med Sci. 2018;73(6):763–9. https://doi.org/10.1093/gerona/glx147.CrossRefPubMed

47.

Hayawi LM, Graham ID, Tugwell P, Yousef AS. Screening for osteoporosis: a systematic assessment of the quality and content of clinical practice guidelines, using the AGREE II instrument and the IOM Standards for Trustworthy Guidelines. PLoS One. 2018;13(12):e0208251. https://doi.org/10.1371/journal.pone.0208251.CrossRefPubMedPubMedCentral

48.

• Molino C, Leite-Santos NC, Gabriel FC, Wainberg SK, Vasconcelos LP, Mantovani-Silva RA, et al. Factors associated with high-quality guidelines for the pharmacologic management of chronic diseases in primary care: a systematic review. JAMA Intern Med. 2019. https://doi.org/10.1001/jamainternmed.2018.7529. This monumental study addresses the question "What makes a high-quality clinical practice guideline in primary care?" based upon the validated Appraisal of Guidelines for Research and Evaluation Instrument, version II (AGREE-II) instrument. The most important factors: having more than 20 authors (odds ratio, 9.08; 95% CI 3.35–24.62), development at governmental institutions (odds ratio, 10.38; 95% CI 2.72–39.60), and reporting funding (odds ratio, 10.34; 95% CI 4.77–22.39). CrossRefPubMed

49.

• Nayak S, Greenspan SL. How can we improve osteoporosis care? A systematic review and meta-analysis of the efficacy of quality improvement strategies for osteoporosis. J Bone Miner Res. 2018;33(9):1585–94. https://doi.org/10.1002/jbmr.3437. A comprehensive review of what works and what does not to improve osteoporosis screening and/or treatment rates. Secondary prevention strategies seem to be better developed and more successful than primary prevention srategieis. CrossRefPubMed

Titel: Population-Based Osteoporosis Primary Prevention and Screening for Quality of Care in Osteoporosis, Current Osteoporosis Reports
verfasst von: William D. Leslie
Carolyn J. Crandall
Publikationsdatum: 31.10.2019
Verlag: Springer US
Erschienen in: Current Osteoporosis Reports / Ausgabe 6/2019
Print ISSN: 1544-1873
Elektronische ISSN: 1544-2241
DOI: https://doi.org/10.1007/s11914-019-00542-w

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2019

Mechanical Regulation of the Maternal Skeleton during Reproduction and Lactation

Inflammation in Fibrodysplasia Ossificans Progressiva and Other Forms of Heterotopic Ossification

Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities

Effects of Diabetes on Bone Material Properties

Correction to: Are CT-Based Finite Element Model Predictions of Femoral Bone Strength Clinically Useful?