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MONTREAL (September 29, 2018) – A coalition of experts, doctors, specialists and rights groups from the world's leading bone health experts today released its clinical recommendations to combat against the public health crisis related to the treatment of osteoporosis and treatment of the debilitating and often deadly hip. fractures of the spine caused by the disease.
The recommendations of the American Society for Bone and Minerals Fracture Prevention Secondary Coalition (more than 40 US and international bone health experts, health professional organizations, and advocacy organizations Patients' rights dedicated to the reduction of avoidable secondary fractures) were presented at the ASBMR 2018 Annual Meeting in Montreal, the world's first scientific congress on bone, mineral and musculoskeletal sciences. Full recommendations and more data on the osteoporosis treatment crisis are available on the new Coalition website: http://www.secondaryfractures.org.
The Coalition's recommendations are the first to define the best clinical care plan for women and men aged 65 and over with hip or spine fractures. They were developed in response to growing evidence of an alarming trend of increased numbers of hip fractures and high-risk osteoporotic patients who require treatment but are not prescribed medication. appropriate, or simply not taking them, despite research demonstrating their effectiveness in preventing fractures. Recent surveys of patients also show that critical information about the link between osteoporosis and the risk of fracture does not reach patients.
"I think a lot of people are shocked to learn that these conversations are not going on and that simple steps are not being taken," said Michael Econs, MD, president of the ASBMR and chief of the Division of Endocrinology and Metabolism and Professor of Medicine at Indiana University School of Medicine. "As physicians, it is our job to help our patients and loved ones understand what they can do to prevent a new fracture, we need to do a better job of communicating with them and each other. to help control this crisis. "
According to a recent poll by the National Osteoporosis Foundation, 96% of postmenopausal women who report they have not been diagnosed with osteoporosis and have suffered a fracture or fracture have not told their doctor that this could be related to osteoporosis. The survey also found that one-third of women who participated in the survey with a fracture had not been referred for follow-up visits by health care providers.
"Patients with heart attacks do not leave the hospital without beta blockers to prevent another, but every day, patients hospitalized for hip or spine fractures do not receive of treatments that, according to the research, help prevent a second fracture that can lead to disability or death, "Coalition Co-Chair Douglas P. Kiel, MD, MPH, was president of the ASBMR, Director of the Musculoskeletal Research Center of the Institute for Research on Aging, Hebrew SeniorLife and Professor of Medicine at Harvard Medical School. "We have joined forces to provide a roadmap for all health care providers, from orthopedic surgeons to primary care physicians, to many other health professionals, to understand what they need to do to prevent fractures and how they can partner with patients to make informed choices regarding osteoporosis treatment options ".
The problem
Only 23% of older patients with a hip fracture receive an osteoporosis medication to reduce the risk of future fracture, compared to 96% of heart attack patients receiving a beta-blocker for prevent a future heart attack.
The risk of additional fractures after a first major osteoporotic fracture is greatest immediately after the first event.
In the United States, the number of hip fractures has recently been on a downward trend for the past 30 years, raising fears that doctors and patients will not follow diagnostic and treatment guidelines.
The costs: human and economic
Although osteoporosis is a highly treatable disease, it is increasing globally and is responsible for more than two million fractures in the United States alone. It is also one of the 10 most expensive chronic diseases for Medicare.
In the United States, out of 300,000 hip fractures each year, one in two patients never reaches their previous functional ability.
One in four hip fractured patients end up in a retirement home.
One in four patients with a hip fracture dies in the year.
Barriers to care
Although the "shortcomings" in the treatment of osteoporosis are due to many reasons, doctors and patients are particularly concerned about the risk of very rare side effects, particularly atypical fractures of the femur-related atypical to the use of osteoporosis drugs called bisphosphonates.
"Patients with hip or vertebral fractures are at a very high risk of serious and life-threatening fractures in the first two years after fractures." These recommendations address what can be done to reduce their risk. future fractures, which include drugs, exercise, nutrition and the reduction of the risk of falling, "said Sundeep Khosla, MD, co-chair of the Coalition and former president of the ASBMR, which is also Director of the Center for Clinical and Translational Research at the Mayo Clinic in Rochester, Minnesota. "Research shows that the risks of atypical fractures of the femur are very rare and that the benefits of taking bisphosphonates far outweigh the risks."
The following key recommendations for clinical care for women and men aged 65 and over with hip or vertebral fractures were developed by the members of the Coalition as part of a consensus process.
Clinical Care Recommendations from the ASBMR Secondary Fracture Prevention Initiative
A fundamental principle of these recommendations is that women and men aged 65 or older with a broken hip or vertebra should be optimally managed in the context of a Multidisciplinary clinical system including case management, such as a fracture liaison service, to ensure that they are properly assessed and treated for osteoporosis and the risk of future fractures.
1. Communicate three simple messages to patients and their families / caregivers throughout the fracture healing and care process:
their broken bone probably means that they are suffering from osteoporosis and that they are at a high risk of fracturing further, especially over the next two years;
breaking bones means that they may, for example, have to use a walker, cane or wheelchair, or move from their home to a residential facility) and run a higher risk of dying prematurely;
more importantly, they can take some steps to reduce their risk.
2. Make sure the primary care provider of the patient is informed of the occurrence of a fracture. If it is impossible to determine if the patient's primary care provider has been notified, take steps to ensure that communication is established.
3. Regularly assess the risk of falls in women and men 65 years of age and older who have had a hip or vertebral fracture.
At a minimum, take the history of their falls over the past year.
Minimize the use of medications associated with an increased risk of falls.
Evaluate patients for conditions associated with increased risk of falls.
Consider strongly refer patients to physiotherapy and / or occupational therapy or physiatrist for evaluation and interventions to improve mobility, gait and balance, and to reduce the risk of falling.
4. Offer pharmacological treatment of osteoporosis to women and men aged 65 or older with a broken hip or vertebra, to reduce the risk of further fractures.
Pharmacological treatment (oral or intravenous) may start at the hospital and be included in discharge orders, although some practitioners prefer to delay zoledronic acid intravenously for a few weeks.
Do not delay initiation of treatment for bone mineral density ("BMD") testing. Although BMD tests can be performed to monitor treatment responses, treatment should be offered independently of BMD levels.
Examine the oral health of patients before starting treatment with bisphosphonates or denosumab.
5. Because osteoporosis is a life-long chronic disease, regularly monitor and reassess women and men aged 65 or older with a broken hip or vertebra and who are being treated for osteoporosis. . The objectives include:
reinforce key messages about osteoporosis and associated fractures
identify barriers to adherence to treatment;
assess the risk of falling;
evaluate the effectiveness of the treatment plan;
monitoring of adverse effects;
determine if any changes need to be made to the treatment, especially if pharmacotherapy for osteoporosis needs to be changed or discontinued.
"All patients with hip fractures or vertebrae should be informed that their broken bone probably means that they are suffering from osteoporosis and that they are running a very high risk of fracturing." "Our goal is for patients, families, and health professionals to understand and take action to prevent future fractures," said Dr. Econs.
To read the full recommendations and learn more about the ASBMR Secondary Fracture Prevention Initiative, go to: http://www.secondaryfratures.org
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