Fracture prevention service to bridge the osteoporosis care gap

Figures & data

Table 1 Multivariate analysis of the association between activation of the Fracture Prevention Service and pharmacological treatment for secondary prevention of fragility fractures at hospital discharge

	Pharmacological secondary prevention
	β	SE	P-value
Fracture unit	0.34	0.04	<0.0001
Age	−0.001	0.002	0.6875
Female sex	0.14	0.05	0.0044
Specific treatment at admission	0.44	0.07	<0.0001
History of fracture	−0.13	0.04	0.0051

Abbreviation: SE, standard error.

Table 2 Multivariate analysis of the association between implementation of the Fracture Prevention Service and 1-year adherence to pharmacological treatment for secondary prevention of fragility fracture

	One-year adherence to secondary prevention
	Β	SE	P-value
Fracture unit	0.19	0.03	<0.0001
Age	−0.001	0.002	0.4864
Female sex	0.09	0.03	0.0154

Notes: Further confounders, including history of fracture, type of fracture, destination at discharge, history of specific treatment, and calcium and/or vitamin D supplementation at hospital admission were tested and excluded from the parsimonious model using stepwise regression method analysis.

Abbreviation: SE, standard error.

Table 3 Characteristics of participants enrolled before (group A) and after (group B) activation of the Fracture Prevention Service according to time of hospital assessment (at admission and at discharge, respectively)

	Group A (n=172)	Group B (n=210)	P-value
Women, n (%)	135 (78.49)	151 (71.90)	0.1400
Age, years, mean ± SD	83.32±8.16	83.52±7.47	0.8090
Clinical characteristics
Type of fracture, n (%)			0.4488
Femoral neck	85 (49.42)	89 (42.38)
– Trochanteric	79 (45.93)	113 (53.81)
– Periprosthetic	2 (1.16)	3 (1.43)
– Subtrochanteric	6 (3.49)	5 (2.38)
Type of surgery, n (%)			0.6178
– Osteosynthesis	103 (59.88)	137 (64.76)
– Prosthesis	68 (39.53)	73 (34.76)
Previous fracture, n (%)	64 (37.21)	75 (35.71)	0.7625
Previous fracture site, n (%)			0.1210
– Femur	34 (53.97)	27 (36.00)
– Vertebra	8 (12.70)	12 (16.00)
– Wrist	9 (14.29)	10 (13.33)
– Other	12 (19.05)	26 (34.66)
Diagnostic and therapy before index fracture
BMD testing, n (%)	3 (1.74)	1 (0.48)	0.2258
Antiosteoporosis drug treatment, n (%)	18 (10.47)	15 (7.14)	0.2502
Calcium and/or vitamin D supplementation, n (%)	19 (11.05)	11 (5.24)	0.0358
Diagnostic and therapy after index fracture
BMD testing, n (%)	25 (14.53)	100 (47.62)	<0.0001
Fall and fractures clinic evaluation, n (%)	4 (2.37)	106 (52.48)	<0.0001
Antiosteoporosis drug treatment, n (%)	29 (17.16)	98 (48.51)	<0.0001
Calcium/vitamin D supplementation, n (%)	28 (16.57)	101 (50.00)	<0.0001

Note: P-value from Fisher’s Exact test, t-test, or chi-square test, as appropriate.

Abbreviations: BMD, bone mineral density; SD, standard deviation.

Table 4 One-year adherence to recommendations prescribed at discharge among participants enrolled before (group A) and after (group B) implementation of the Fracture Prevention Service

	Group A	Group B	P-value
Participants contributing to baseline, n (%)	172 (100%)	210 (100%)	–
One-year mortality, n (%)	22 (12.7)	33 (15.7)	0.5011
One-year dropout, n (%)	34 (19.76)	35 (16.66)	0.4332
Participants contributing to 1-year follow-up, n (%)	116 (67.44)	142 (67.61)	0.1655
BMD testing, n (%)	24 (20.68)	62 (43.66)	<0.0001
Fall and fracture clinic attendance, n (%)	6 (5.17)	78 (54.92)	<0.0001
Specific antifracture drug therapy, n (%)	17 (14.65)	56 (39.43)	<0.0001
Calcium plus vitamin D supplementation, n (%)	10 (8.62)	65 (45.77)	<0.0001

Note: P-value from Fisher’s Exact test, t-test, or chi-square test, as appropriate.

Abbreviation: BMD, bone mineral density.