The Greek challenging reality of fragility fractures and inspirations for the future
Keywords:
: Fragility fractures, Osteoporosis, Orthogereatrics, Falls prevention, multidisciplinary approachAbstract
A different type of pandemic has been challenging the last decades the global health care systems. These are the fragility fractures, which are linked with increased morbidity, mortality and impairment of the quality of life of the elderly. National health care systems are burdened with treating these demanding patients, consuming large amounts of resources, financial and medical. This fact has led to the need for more optimal utilisation of the existing resources.
Patients with fragility fractures have multiple co-morbidities and optimally they need a multi-disciplinary approach for their management. For this a team of healthcare professionals has to be formed, involving orthogeriatricians, orthopaedics, physiotherapists, anaesthetists, nurses, dieticians and many more. Another important aspect of this problem is the primary and secondary prevention of the fragility fractures, mainly by diagnosing and treating the osteoporosis and preventing the falls of the elderly population.
The Fragility Fracture Network is a global organisation with the vision to create a society where the elderly receives high quality care and have improved quality of life. Its aim is to spread the information and the means to achieve this goal globally. In the present article we discuss all of these aspects focusing on the local challenges of the Greek health care system and present some inspirations for the future.
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References
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25. Morrissey N, Iliopoulos E, Osmani AW, Newman K. Neck of femur fractures in the elderly: Does every hour to surgery count? Injury. 2017;48(6).
26. Mitchell PJ. Fracture liaison services: the UK experience. Osteoporos Int. 2011;22(3):487–94.
27. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, et al. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int. 2013;24(2):393–406.
28. Walters S, Khan T, Ong T, Sahota O. Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging. 2017;12:117.
29. Barton DW, Piple AS, Smith CT, Moskal SA, Carmouche JJ. The clinical impact of fracture liaison services: a systematic review. Geriatr Orthop Surg Rehabil. 2021;12:2151459320979978.
30. Skelton DA, Rutherford OM, Dinan-Young S, Sandlund M. Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis. J frailty, sarcopenia falls. 2019;4(1):11.
31. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane database Syst Rev. 2019;(1).
2. Organization WH. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]. World Health Organization; 1994.
3. Kanis JA, Oden A, McCloskey E V, Johansson H, Wahl DA, Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23(9):2239–56.
4. Borgström F, Karlsson L, Ortsäter G, Norton N, Halbout P, Cooper C, et al. International Osteoporosis Foundation, Fragility fractures in Europe: burden, management and opportunities, Arch. Osteoporos. 15 (1)(2020 Apr 19) 59.
5. Makras P, Anastasilakis AD, Antypas G, Chronopoulos E, Kaskani EG, Matsouka A, et al. The 2018 Guidelines for the diagnosis and treatment of osteoporosis in Greece. Arch Osteoporos. 2019;14(1):1–10.
6. Διονυσιώτης Ι, Καψοκούλου Α, Σαμλίδη Ε, Παπαθανασίου Ι. Αναθεωρήσεις στην αποκατάσταση του ηλικιωμένου ασθενούς με κάταγμα ισχίου. Arch Hell Med Ellenikes Iatrikes. 2019;36(2).
7. Harvey NCW, McCloskey E V, Mitchell PJ, Dawson-Hughes B, Pierroz DD, Reginster J-Y, et al. Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int. 2017;28(5):1507–29.
8. Lems WF, Raterman HG. Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs. Ther Adv Musculoskelet Dis. 2017;9(12):299–316.
9. Ross BJ, Lee OC, Harris MB, Dowd TC, Savoie III FH, Sherman WF. Rates of osteoporosis management and secondary Preventative treatment after primary fragility fractures. JBJS Open Access. 2021;6(2).
10. Bougioukli S, Κollia P, Koromila T, Varitimidis S, Hantes M, Karachalios T, et al. Failure in diagnosis and under-treatment of osteoporosis in elderly patients with fragility fractures. J Bone Miner Metab. 2019;37(2):327–35.
11. Drosos G, Kougioumtzis I, Tottas S, Titsi Z, Ververidis A, Tilkeridis K. Elderly patients with hip fractures, treatment for osteoporosis, evidence for sarcopenia and malnutrition. A preliminary report. Therapy. 8:0.
12. Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, et al. Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc. 2007;55(3):407–13.
13. Ranhoff AH, Holvik K, Martinsen MI, Domaas K, Solheim LF. Older hip fracture patients: three groups with different needs. BMC Geriatr. 2010;10(1):1–7.
14. Nordström P, Gustafson Y, Michaëlsson K, Nordström A. Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. Bmj. 2015;350.
15. Folbert EC, Hegeman JH, Gierveld R, Van Netten JJ, Velde D van der, Ten Duis HJ, et al. Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Arch Orthop Trauma Surg. 2017;137(4):507–15.
16. Pioli G, Bendini C, Pignedoli P, Giusti A, Marsh D. Orthogeriatric co-management–managing frailty as well as fragility. Injury. 2018;49(8):1398–402.
17. Pan L, Ning T, Wu H, Liu H, Wang H, Li X, et al. Prognostic nomogram for risk of mortality after hip fracture surgery in geriatrics. Injury. 2022;53(4):1484–9.
18. Makridis KG, Badras LS, Badras SL, Karachalios TS. Searching for the ‘winner’hip fracture patient: the effect of modifiable and non-modifiable factors on clinical outcomes following hip fracture surgery. Hip Int. 2021;31(1):115–24.
19. Molla Moustafa R, Tottas S, Karaglani M, Tilkeridis K, Ververidis A, Drosos G. 3 rd Panhellenic Conference of Fragility Fracture Network Greece ( FFN GR ) “ Necessity of Interdisciplinarity and Networking .” 2022;22(1):142–50.
20. Lizaur-Utrilla A, Serna-Berna R, Lopez-Prats FA, Gil-Guillen V. Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis. Arch Orthop Trauma Surg. 2015;135(12):1663–7.
21. Elkassabany NM, Passarella M, Mehta S, Liu J, Neuman MD. Hospital characteristics, inpatient processes of care, and readmissions of older adults with hip fractures. J Am Geriatr Soc. 2016;64(8):1656–61.
22. Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, et al. Imminent risk of fracture after fracture. Osteoporos Int. 2017;28(3):775–80.
23. Sobolev B, Sheehan KJ, Kuramoto L, Guy P. Excess mortality associated with second hip fracture. Osteoporos Int. 2015;26(7):1903–10.
24. Dreinhöfer KE, Mitchell PJ, Bégué T, Cooper C, Costa ML, Falaschi P, et al. A global call to action to improve the care of people with fragility fractures. Injury. 2018;49(8):1393–7.
25. Morrissey N, Iliopoulos E, Osmani AW, Newman K. Neck of femur fractures in the elderly: Does every hour to surgery count? Injury. 2017;48(6).
26. Mitchell PJ. Fracture liaison services: the UK experience. Osteoporos Int. 2011;22(3):487–94.
27. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, et al. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int. 2013;24(2):393–406.
28. Walters S, Khan T, Ong T, Sahota O. Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging. 2017;12:117.
29. Barton DW, Piple AS, Smith CT, Moskal SA, Carmouche JJ. The clinical impact of fracture liaison services: a systematic review. Geriatr Orthop Surg Rehabil. 2021;12:2151459320979978.
30. Skelton DA, Rutherford OM, Dinan-Young S, Sandlund M. Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis. J frailty, sarcopenia falls. 2019;4(1):11.
31. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane database Syst Rev. 2019;(1).
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2023-12-28
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