Improving Secondary Fracture Prevention After Vertebroplasty: Implementation of a Fracture Liaison Service |
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| Institution: | 1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;2. Department of Radiology, University of Colorado—Anschutz Medical Campus, Denver, Colorado;3. Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;4. Director of Musculoskeletal Ultrasound and Fellowship Director for Musculoskeletal Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;1. Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio;2. Northwest Radiology, St Vincent Health, Indianapolis, Indiana;3. Harvey L. Neiman Health Policy Institute, Reston, Virginia;4. Executive Director, Harvey L. Neiman Health Policy Institute, Reston, Virginia;5. Director of Scholarly Activity/Research, Department of Radiology, Ohio State University, Wexner Medical Center, Columbus, Ohio;1. Vice Chair of Communications, Division Chief of Neuroradiology;2. Vice Chair of Education, Neuroradiology Fellowship Director, Department of Radiology, Division of Neuroradiology;3. Radiology Vice Chair for Academic Affairs, Interim Chief of Neuroradiology, Department of Radiology, Division of Neuroradiology;1. Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida;2. Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri;3. Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland;4. Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota;1. Mayo Clinic Alix School of Medicine, Scottsdale, Arizona;2. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;1. UCSF, San Francisco, California;2. Clinical Chief of Musculoskeletal Radiology for Virtual Radiologic, Eden Prairie, Minnesota;3. Emory University, Atlanta, Georgia;4. Professor and Chair of the Department of Radiology, University of Vermont, Burlington, Vermont;5. Professor and Vice Chair for Quality & Safety and Chief of Emergency Radiology at Penn State Milton S. Hershey Medical Center, Penn State Health and Penn State College of Medicine, Hershey, Pennsylvania;1. Department of Radiology and Medical Imaging, Emory University, School of Medicine, Johns Creek, Georgia;2. Department of Radiology, Wellspan-Summit Health, Chambersburg, Pennsylvania |
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| Abstract: | ObjectiveThe aim of our study was to evaluate a multidisciplinary fracture liaison service (FLS) to improve osteoporosis treatment and secondary fracture prevention for patients after vertebroplasty.MethodsA retrospective chart review of consecutive vertebroplasty patients from January 2016 to January 2020. FLS began in December 2016 allowing for before-and-after comparison. Statistical analysis included patient demographics and procedure characteristics. Proportion of patients evaluated by the FLS clinic and treatment modification were evaluated. Opt-in versus opt-out referral strategies were compared. Dual energy x-ray absorptiometry scans or vitamin D levels within 3 months before or after vertebroplasty were assessed. Time to event analysis was used to evaluate secondary fracture occurrence.ResultsThere were 137 vertebroplasty patients, 39 before FLS and 98 after FLS, included. Only 15% of all patients were already being treated in a bone health clinic. Of those referred and evaluated by the FLS, 73.0% had their osteoporosis treatment modified. Patients evaluated by the FLS were more likely to have a dual energy x-ray absorptiometry scan or a vitamin D level drawn (P < .001 for both). The opt-out referral was more effective with a 75.0% referral rate (P = .71). Secondary fracture of any kind occurred in 23.4% of all patients. Time to event analysis demonstrated a trend toward a reduced risk of secondary spinal fractures in the fracture prevention group with an adjusted hazard ratio of 0.39 (0.13-1.11, 95% confidence interval).DiscussionA multidisciplinary FLS can be implemented for patients after vertebroplasty to evaluate osteoporotic risk factors and optimize osteoporosis therapy, both of which are important factors in preventing secondary vertebral fractures. |
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| Keywords: | Fragility fracture fracture liaison service osteoporosis Own the Bone vertebroplasty |
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