Der „Osteoporosis Care Gap“ bei Altersfrakturpatienten kann durch osteologische Begleitung entlang des Behandlungspfads minimiert werden!

Zusammenfassung

Einleitung Ein Fracture Liaison Service (FLS) gilt als geeignete Organisationsstruktur, um den „Osteoporosis Care Gap“ zu schließen.

Material und Methodik In diese FLS-Evaluations-Studie wurden zwischen 01/2014 und 12/2015 insgesamt 1270 Patienten > 65 Jahre eingeschlossen, die am Universitätsspital Basel wegen einer Fraktur nach Niederenergietrauma behandelt wurden. Im persönlichen Gespräch konnte das FLS Team die Osteoporoserisikofaktoren erheben und eine ggf. bereits durchgeführte Osteoporosediagnostik oder -therapie erfragen. Auf dieser Basis wurden das individuelle Frakturrisiko errechnet und der Bedarf an weiterer Osteoporosediagnostik oder -therapie festgelegt.

Resultate Das grosse, heterogene Kollektiv von Patienten mit Altersfraktur konnte auf diese Art in kleinere Patientengruppen mit jeweils ähnlichen Abklärungsbedürfnissen aufgeteilt werden. Dabei wurden 21 % der Patienten als bereits ausreichend abgeklärt und behandelt erkannt. Bei weiteren 67 % der Patienten konnten Massnahmen zur sekundären Frakturprävention bedarfsgerecht eingeleitet werden.

Schlussfolgerung Mit unserem FLS Modell konnte die Versorgungslücke auf 12 % der Patienten verringert werden.

Abstract

Introduction Only 20 % of elderly patients are said to receive osteoporosis diagnostics and treatment after sustaining their first fragility fracture. The remaining 80 % are either underdiagnozed and undertreated, or their status with respect to diagnostics of osteoporosis is unknown, which constitutes the so called “osteoporosis care gap”. Fracture Liaison Services (FLS) are an effective structure to close this care gap. Herewith we report, by which type of measures and to which extent the care gap could be closed with an FLS.

Material and Methods Our FLS functions as cooperation between the Clinic for Orthopaedic and Trauma Surgery of University Hospital Basel and a private osteoporosis outpatient clinic, “ENDONET”. All patients older than 65 who were treated for a fragility fracture between January 2014 and December 2015 were identified. Patients, with fractures after high energy trauma, those caused by metastatic bone disease, or patients with fractures of the skull, the fingers, or toes were excluded. Recommendation for basic osteoporosis prophylaxis was offered to all patients. In-person case finding was performed in the hospital to decide on the following questions:
- Need for diagnostics and possible therapy of osteoporosis
- Acceptability to perform these measures by ENDONET.

Results 1270 patients were included in this retrospective analysis. 105 patients (8 %) refused measures of secondary fracture prevention, and in 153 patients (12 %), no additional measures other than implementation of osteoporosis basic prophylaxis were required according to the guidelines. 115 patients (9 %) were already subject of a controlled osteoporosis treatment at the time of fracture and did not require an additional workup. ENDONET referral was arranged for 147 patients (12 %) for primary osteoporosis workup, and for 245 patients (19 %) to repeat a prior osteoporosis workup. 44 patients (4 %) did not keep their ENDONET appointment. In 505 patients (40 %), the case finding did not result in a proposition of ENDONET referral, because the patient decided to implement our recommendations for secondary fracture prevention autonomously or in collaboration with their general practitioner, or because the patients were of such a poor general health that an osteoporosis workup was considered inadequate.

Conclusion By means of in-person case finding, the large heterogeneous cohort of fragility fracture patients could be grouped into smaller, more homogeneous samples with similar needs in terms of osteoporosis diagnostics and treatment. The “osteoporosis care gap” is simultaneously reduced in two ways: firstly, already sufficiently treated patients are identified as such – and therefore do no longer contribute to calculations of the care gap; secondly, the in-person case finding helps to reduce the number of patients who refuse participation in measures of secondary fracture prevention in spite of an indication. In our setting, the care gap was diminished to as little as 12 %.

Schlüsselwörter

Osteoporose Care Gap - Versorgungslücke - Fracture Liaison Service - Altersfraktur

Key words

osteoporosis care gap - fracture liaison service - fragility fractures

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