From the Guidelines
The 3 "I's" (Identification, Investigation, and Intervention) are crucial components of post-fracture care, with the Fracture Liaison Service (FLS) model being the most effective organisational structure for risk evaluation and treatment initiation, as evidenced by a systematic review and meta-analysis 1. The Identification step involves systematically evaluating patients aged 50 years and over with a recent fracture for the risk of subsequent fractures, which can be achieved through a dedicated coordinator who takes care of all aspects of the process.
- This coordinator, often a well-educated nurse, works under the supervision of an orthopaedic surgeon, an endocrinologist, or a rheumatologist to identify elderly patients with a recent fracture in the hospital.
- The Investigation phase encompasses diagnostic investigations, such as bone mineral density testing, fall risk evaluation, and laboratory tests to identify secondary causes of osteoporosis.
- The Intervention component involves starting interventions, providing adequate medical information to patients and primary care physicians (PCPs), and implementing evidence-based treatments to reduce future fracture risk. Key aspects of the Intervention include:
- Providing specific patient education
- Alerting the PCP by means of a discharge letter containing medical information on the fracture of the patient
- Initiating osteoporosis treatment, with studies showing that a nominated coordinator significantly improves the implementation of osteoporosis treatment after a fragility fracture 1. By applying the 3 "I's" framework through an FLS model, healthcare systems can significantly reduce the burden of secondary fractures and improve patient outcomes, with a nominated coordinator improving the implementation of osteoporosis treatment after a fragility fracture, resulting in 45% of patients receiving appropriate management, compared to 26% in the control group 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Role of Identification (ID) in Post-Fracture Care
- Identification of patients with osteoporosis who have been hospitalized for major fractures is crucial in post-fracture care 2
- Patients diagnosed with osteoporosis can be identified from national health insurance research databases, allowing for follow-up and analysis of survival outcomes 2
Role of Investigation in Post-Fracture Care
- Investigation of the efficacy and safety of medications used to prevent fractures is essential in post-fracture care 3, 4, 5, 6
- Studies have investigated the antifracture efficacy of various medications, including bisphosphonates, denosumab, and teriparatide, in preventing spine, nonspine, and hip fractures 3, 4, 5
- Investigation of the long-term safety of these medications has also been conducted, with findings indicating that the safety profile of most available drugs for the treatment of osteoporosis is well defined 6
Role of Intervention in Post-Fracture Care
- Intervention with bisphosphonates, such as zoledronic acid, ibandronate, and alendronate, has been shown to reduce post-fracture mortality among patients with osteoporosis 2
- Intervention with risedronate gastro-resistant has been shown to have a lower incidence of fractures compared to other oral bisphosphonates 5
- The choice of intervention should consider the balance between the beneficial effects of treatment, the probability of adverse effects, and costs, particularly in patients at low risk of fracture 6
- A "drug holiday" may be considered after 5-10 years of bisphosphonate treatment, depending on fracture risk and pharmacokinetics of the bisphosphonate used 4