nach oben

Erschienen in:

01.12.2015 | Original Article

Swedish osteoporosis care

verfasst von: Emma Jonsson, Daniel Eriksson, Kristina Åkesson, Östen Ljunggren, Stina Salomonsson, Fredrik Borgström, Oskar Ström

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2015

Einloggen, um Zugang zu erhalten

Summary

Mini-abstract

The objective of this study was to review and describe the current state of Swedish osteoporosis care and to highlight ongoing challenges. This report encompasses quantitative health outcomes based on Swedish registry data as well as organizational and management aspects.

Executive summary

Swedish osteoporosis care is characterized by a significant burden of disease, difficulties in identifying high-risk patients, and fragmented pathways for patients in need of secondary fracture prevention. This report aimed to describe the current state, gaps, and challenges in Swedish osteoporosis care, using Swedish national databases, questionnaires, and interviews with healthcare representatives. A secondary aim was to develop quality and process measures to compare differences between counties and to use those measures to describe the interaction between quantitative health outcomes and aspects of care organization and management. In conjunction with fractures, a considerably smaller proportion of men are treated than women, and a smaller proportion of older women are treated compared to younger groups. Between 3 and 16 % of patients receive treatment after a fracture, and the treatment rate in this patient group can likely increase. In addition to an unsatisfactory treatment rate, a limited number of those treated continue treatment throughout the recommended treatment durations, leading to increased risk of fracture. With a substantial variation between counties, there is a clear difficulty to identify non-persistent patients and switch to an alternative treatment. Collaboration around the patient across specialties has been lacking, and systems for secondary prevention have been concentrated to a few counties. However, when this study was conducted, there was a general trend towards implementing regional care programs. This report suggests possible strategies for improving quality of care and, hopefully, it can provide a basis for future evaluations and regional improvement of osteoporosis care in Sweden and other countries.

Nur mit Berechtigung zugänglich

This report defines major osteoporotic fracture in the same way as in Quality and Efficiency in Swedish Healthcare; ICD-10 S32.1-8, S52.5-6, S42.2-3, S72.0-4, S22.x, S82.1.

Only patients with a first care occasion in inpatient care for any of the defined diagnosis codes are included.

For example, in the report “Unequal conditions for health and healthcare” [Ojämna villkor för hälsa och vård: Jämlikhetsperspektiv på hälso- och sjukvården”], the National Board of Health and Welfare reports challenges in certain healthcare areas where national guidelines are in place [59].

Giangregorio L et al (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35(5):293–305PubMedCrossRef

SKL och Socialstyrelsen (2012) Öppna Jämförelser av hälso- och sjukvårdens kvalitet och effektivitet

Strom O et al (2011) Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6(1-2):59–155PubMedCrossRef

Kanis JA et al (2013) SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos 8(1-2):144PubMedPubMedCentralCrossRef

Elliot-Gibson V et al (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15(10):767–78PubMedCrossRef

SKL och Socialstyrelsen (2013) Öppna Jämförelser 2013-Läkemedelsbehandlingar-Jämförelser mellan landsting

SBU (2003) Osteoporos—prevention, diagnostik och behandling. (165/1, 165/2)

Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4(6):368–81PubMedCrossRef

Melton LJ 3rd (2001) The prevalence of osteoporosis: gender and racial comparison. Calcif Tissue Int 69(4):179–81PubMedCrossRef

10.

Kanis JA et al (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27(5):585–90PubMedCrossRef

11.

Statistiska Centralbyrån (SCB). 2014-02-21.

12.

Olszynski WP et al (2004) Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment. Clin Ther 26(1):15–28PubMedCrossRef

13.

Cooper C et al (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res 7(2):221–7PubMedCrossRef

14.

Hasserius R et al (2005) Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly—a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 76(4):235–42PubMedCrossRef

15.

Barrett JA, Baron JA, Beach ML (2003) Mortality and pulmonary embolism after fracture in the elderly. Osteoporos Int 14(11):889–94PubMedCrossRef

16.

Jonsson B et al (2011) Cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 22(3):967–82PubMedCrossRef

17.

Jalava T et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18(7):1254–60PubMedCrossRef

18.

RIKSHÖFT (2012) Årsrapport 2012

19.

Borgstrom F et al (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17(5):637–50PubMedCrossRef

20.

Marsh D et al (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22(7):2051–65PubMedCrossRef

21.

Gillespie LD et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146PubMed

22.

Jarvinen TL et al (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336(7636):124–6PubMedPubMedCentralCrossRef

23.

Socialstyrelsen (2012) Nationella riktlinjer för rörelseorganens sjukdomar

24.

Marie PJ (2006) Strontium ranelate: a dual mode of action rebalancing bone turnover in favour of bone formation. Curr Opin Rheumatol 18(Suppl 1):S11–5PubMedCrossRef

25.

Tandvårds- och läkemedelsverket (www.TLV.se). 2013-12-19]

26.

SKL och Socialstyrelsen (2013) Öppna Jämförelser av hälso- och sjukvårdens kvalitet och effektivitet

27.

McLellan AR et al (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22(7):2083–98PubMedCrossRef

28.

Kanis JA, WHO Scientific Group Technical Report (2007) Assessment of osteoporosis at the primary health care level: University of Sheffield

29.

Strom O et al (2010) FRAX and its applications in health economics—cost-effectiveness and intervention thresholds using bazedoxifene in a Swedish setting as an example. Bone 47(2):430–7PubMedCrossRef

30.

Kanis JA, Reginster JY (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women—what is the current message for clinical practice? Pol Arch Med Wewn 118(10):538–40PubMed

31.

Hernlund E et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8(1-2):136PubMedPubMedCentralCrossRef

32.

Kanis JA et al (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57PubMedPubMedCentralCrossRef

33.

Kanis JA et al (2014) Worldwide uptake of FRAX. Arch Osteoporos 9(1):166PubMedCrossRef

34.

Pye SR et al (2003) Frequency and causes of osteoporosis in men. Rheumatology (Oxford) 42(6):811–2CrossRef

35.

Geusens P et al (2008) Impact of systematic implementation of a clinical case finding strategy on diagnosis and therapy of postmenopausal osteoporosis. J Bone Miner Res 23(6):812–8PubMedCrossRef

36.

Kanis JA et al (2009) How to decide who to treat. Best Pract Res Clin Rheumatol 23(6):711–26PubMedCrossRef

37.

SKL och Socialstyrelsen (2011) Öppna Jämförelser av hälso- och sjukvårdens kvalitet och effektivitet

38.

Ettinger B, Chidambaran P, Pressman A (2001) Prevalence and determinants of osteoporosis drug prescription among patients with high exposure to glucocorticoid drugs. Am J Manag Care 7(6):597–605PubMed

39.

Chami G et al (2006) Are osteoporotic fractures being adequately investigated? A questionnaire of GP & orthopaedic surgeons. BMC Fam Pract 7:7PubMedPubMedCentralCrossRef

40.

Feldstein AC et al (2008) Harnessing stakeholder perspectives to improve the care of osteoporosis after a fracture. Osteoporos Int 19(11):1527–40PubMedCrossRef

41.

(IOF), I.O.F (2012) Capture the fracture: a global campaign to break the fragility fracture cycle: http://www.iofbonehealth.org/

42.

Majumdar SR et al (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 169(1):25–31PubMedCrossRef

43.

Sander B et al (2008) A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. J Bone Joint Surg Am 90(6):1197–205PubMedCrossRef

44.

Kanis JA et al (2005) Intervention thresholds for osteoporosis in the UK. Bone 36(1):22–32PubMedCrossRef

45.

Kanis JA et al (2012) FRAX((R)) with and without bone mineral density. Calcif Tissue Int 90(1):1–13PubMedCrossRef

46.

Klotzbuecher CM et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–39PubMedCrossRef

47.

Kanis JA et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19(6):893–9PubMedCrossRef

48.

Strom O et al (2010) Cost-effectiveness of balloon kyphoplasty in patients with symptomatic vertebral compression fractures in a UK setting. Osteoporos Int 21(9):1599–608PubMedCrossRef

49.

Socialstyrelsen (2012) Nationella riktlinjer för rörelseorganens sjukdomar- Vetenskapligt underlag

50.

Johnell O et al (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15(3):175–9PubMedCrossRef

51.

Boonen S et al (2012) Postmenopausal osteoporosis treatment with antiresorptives: effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective. J Bone Miner Res 27(5):963–74PubMedCrossRef

52.

De Geest S, Sabate E (2003) Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs 2(4):323PubMedCrossRef

53.

Haynes RB, McDonald HP, Garg AX (2002) Helping patients follow prescribed treatment: clinical applications. JAMA 288(22):2880–3PubMedCrossRef

54.

Landfeldt E et al (2012) Adherence to treatment of primary osteoporosis and its association to fractures—the Swedish Adherence Register Analysis (SARA). Osteoporos Int 23(2):433–43PubMedCrossRef

55.

Silverman SL, Gold DT (2008) Compliance and persistence with osteoporosis therapies. Curr Rheumatol Rep 10(2):118–22PubMedCrossRef

56.

Landfeldt E, Lundkvist J, Strom O (2011) The societal burden of poor persistence to treatment of osteoporosis in Sweden. Bone 48(2):380–8PubMedCrossRef

57.

Diez-Perez A et al (2012) Treatment failure in osteoporosis. Osteoporos Int 23(12):2769–74PubMedCrossRef

58.

Gleeson T et al (2009) Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review. Osteoporos Int 20(12):2127–34PubMedPubMedCentralCrossRef

59.

Socialstyrelsen (2011) Ojämna villkor för hälsa och vård- Jämlikhetsperspektiv på hälso och sjukvården: http://www.socialstyrelsen.se/publikationer2011/2011-12-30

60.

Socialstyrelsen och SKL (2009) Mot en effektivare kunskapsstyrning. Kartläggning och analys av nationellt och regionalt stöd före en evidensbaserad praktik i hälso- och sjukvården

61.

Fernler K (2012) Kunskapsstyrning för ledning och policyarbete

Titel: Swedish osteoporosis care
verfasst von: Emma Jonsson
Daniel Eriksson
Kristina Åkesson
Östen Ljunggren
Stina Salomonsson
Fredrik Borgström
Oskar Ström
Publikationsdatum: 01.12.2015
Verlag: Springer London
Erschienen in: Archives of Osteoporosis / Ausgabe 1/2015
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-015-0222-7

Arthropedia

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

Neu im Fachgebiet Orthopädie und Unfallchirurgie

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Update Orthopädie und Unfallchirurgie

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

Newsletter bestellen

Springer Medizin

Swedish osteoporosis care

Summary

Mini-abstract

Executive summary

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie

Springer Medizin

Summary

Mini-abstract

Executive summary

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

Weitere Artikel der Ausgabe 1/2015

Estimating osteoporotic fracture risk following a wrist fracture: a tale of two systems

Change in incidence of hip fracture in Gwangju City and Jeonnam Province, Korea, over 20 years

Yield and cost-effectiveness of laboratory testing to identify metabolic contributors to falls and fractures in older persons

Comments on Korthoewer and Chandran: Osteoporosis management and the utilization of FRAX®: a survey amongst health care professionals of the Asia-Pacific

Carpal and scaphoid fracture incidence in south-eastern Australia: an epidemiologic study

Association between HIV infection and bone mineral density in climacteric women

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie