( Del Pino Montes J1, Blanch Rubio J2, Lizán Tudela L3, Marín Montañés N4 1 Hospital Clínico Universitario de Salamanca Summary Keywords: postmenopausal osteoporosis, osteoporotic fracture, management of the disease, bibliographical review. Introduction Osteoporosis is a disease
characterised by a reduction in bone mass and changes in the microarchitecture of bone tissue which result in an increase in fragility, and consequently, a high risk of fractures1. These may occur in any part of the skeleton, although the areas most affected are the spinal column, the distal radius (Colles fracture) and the hip2. It has been estimated that a woman of 50 years of age has a 40% risk of suffering a fracture during the rest of her life, while in men this risk
is 13%2. Objectives To carry out a systematic literature review on the care pathwayfollowed by patients with fracture due to OP in normal clinical practice in a hospital setting, especially taking into account the different medical specialisms involved. Secondary To determine how each specialism influences the hospital care pathway followed by these patients, and to describe which are the most common referral services in and from the hospital. Methodology The criteria for including articles were those: Excluded were: Search strategy To identify the most relevant studies to be included in the bibliographical review, a search was made of the following: Pubmed/MedLine database (including the Medex and Ibecs databases). ISI Web of knowledge (including the Web of Science, Current Contents Connect ISI Proceedings, Derwent Innovations Index, Journal Citations Report, Essential Science Indicators), Embase and the grey literature in Google Scholar, as well the bibliographical reference lists in the articles selected. In Pubmed various
combinations of Mesh terms were used: The following terms were used in the search with
the ISI Web of Knowledge: The search strategy for the IME database (Índice Médico Español): In addition, in the Google Scholar database a search was carried out using the terms “practice patterns in postmenopausal osteoporosis and fracture” “postmenopausal osteoporosis fracture intervention”. The following local databases were also explored: IBECS (Índice Bibliográfico Español en Ciencias de la Salud) and MEDES (Medicina en Español) applying similar search terms in Spanish. Results The search showed up a total of 114 articles as candidates for review. After discarding non-relevant publications,
duplicated articles and those published in a language other than English or Spanish, 13 articles were selected. 4 articles were excluded for various reasons (n=2: osteoporosis screening, n=1 risk factors for osteoporosis, n=1: costs study) (Figure 1). Articles selected 1.- International multicentred 2.- United States 3.- Canada 4.- Switzerland National guides to clinical practice: do these reflect the intra-hospital care pathway after an osteoporotic fracture? Discussion The literature published regarding the medical care pathway and the professions involved in the management of patients with osteoporotic fracture is limited. With respect to the
extra-hospital environment, what stood out in the articles reviewed was the essential role of the orthopaedic surgeon, inferring the necessity of coordinating their activity with that of the family doctor to guarantee the most appropriate follow up of those patients and the prevention of second fractures. However, in the sources consulted, there were no publications which described, for example, the care pathway followed by a patient with a fracture due to OP in the hospital setting in our
country. Conclusions According to the sources consulted, there is little (or no) descriptive information on the care pathway followed by a patient with osteoporotic fracture, or regarding the professionals involved, at either a national or international level. It is opportune, in the absence of a review of internally disseminated hospital guides, to highlight the need to carry out observational studies which reflect the care pathway followed by this type of patient in the hospital setting. Acknowledgements: The study was sponsored by Amgen S.A. The authors would like to thank Luis Lizán and Julia Villar of Outcomes’10 and Clara Conill of Amgen for their editorial assistance in the preparation of this publication. Conflict of interest: The study was sponsored by Amgen S.A. Dr Núria Márin works for Amgen S.A. Dr Luís Lizán works for Outcomes´10 and Drs Blanch and del Pino are specialists who carry out most of their work in the Spanish public health system. BIBLIOGRAPHY |