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Multicenter Study
. 2016 Mar;27(3):873-879.
doi: 10.1007/s00198-015-3443-0. Epub 2015 Dec 9.

Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate

A Nakayama  1 , G Major  2   3 , E Holliday  4   5 , J Attia  4   5 , N Bogduk  1   4
Affiliations
Multicenter Study

Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate

A Nakayama et al. Osteoporos Int. 2016 Mar.

Abstract

Summary: We assessed the ability of a fracture liaison service (FLS) to directly reduce re-fracture risk. Having a FLS is associated with a ∼40% reduction in the 3-year risk of major bone and ∼30% of any bone re-fracture. The number needed to treat to prevent a re-fracture is 20.

Introduction: FLS have been promoted as the most effective interventions for secondary fracture prevention, and while there is evidence of increased rate of investigation and treatment at institutions with a FLS, only a few studies have considered fracture outcomes directly. We therefore sought to evaluate the ability of our FLS to reduce re-fracture risk.

Methods: Historical cohort study of all patients ≥50 years presenting over a 6-month period with a minimal trauma fracture (MTF) to the emergency departments of a tertiary hospital with a FLS, and one without a FLS. Baseline characteristics, mortality and MTFs over a 3-year follow-up were recorded.

Results: Five hundred fifteen patients at the FLS hospital and 416 patients at the non-FLS hospital were studied. Over 3 years, 63/515 (12%) patients at the FLS hospital and 70/416 (17%) at the non-FLS hospital had a MTF. All patients were analysed in an intention-to-treat analysis regardless of whether they were seen in the FLS follow-up clinic. Statistical analysis using Cox proportional hazard models in the presence of a competing risk of death from any cause was used. After adjustment for baseline characteristics, there was a ∼30% reduction in rate of any re-fracture at the FLS hospital (hazard ratio (HR) 0.67, confidence interval (CI) 0.47-0.95, p value 0.025) and a ∼40% reduction in major re-fractures (hip, spine, femur, pelvis or humerus) (HR 0.59, CI 0.39-0.90, p value 0.013).

Conclusions: We found a ∼30% reduction in any re-fractures and a ∼40% reduction in major re-fractures at the FLS hospital compared with a similar non-FLS hospital. The number of patients needed to treat to prevent one new fracture over 3 years is 20.

Keywords: Bone/prevention and control; Fracture liaison service; Fractures; Osteoporosis/epidemiology; Osteoporotic fractures/prevention and control; Secondary prevention.

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Conflict of interest statement

Conflicts of interest

None.

Figures

Fig. 1
Fig. 1
Flow diagram
Fig. 2
Fig. 2
Cumulative incidence of any re-fracture for the FLS and non-FLS hospitals, adjusted for age group and original fracture type (major/minor)
Fig. 3
Fig. 3
Cumulative incidence of major re-fracture for the FLS and non-FLS hospitals, adjusted for age group, gender and original fracture type (major/minor)
See this image and copyright information in PMC

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