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. 2016 Nov;27(11):3165-3175.
doi: 10.1007/s00198-016-3643-2. Epub 2016 May 26.

Effectiveness of a minimal resource fracture liaison service

K F Axelsson  1   2   3 , R Jacobsson  4 , D Lund  5 , M Lorentzon  6   7
Affiliations

Effectiveness of a minimal resource fracture liaison service

K F Axelsson et al. Osteoporos Int. 2016 Nov.

Abstract

Purpose: The purpose of this study was to investigate if a 2-year intervention with a minimal resource fracture liaison service (FLS) was associated with increased investigation and medical treatment and if treatment was related to reduced re-fracture risk.

Methods: The FLS started in 2013 using existing secretaries (without an FLS coordinator) at the emergency department and orthopaedic wards to identify risk patients. All patients older than 50 years of age with a fractured hip, vertebra, shoulder, wrist or pelvis were followed during 2013-2014 (n = 2713) and compared with their historic counterparts in 2011-2012 (n = 2616) at the same hospital. Re-fractures were X-ray verified. A time-dependent adjusted (for age, sex, previous fracture, index fracture type, prevalent treatment, comorbidity and secondary osteoporosis) Cox model was used.

Results: The minimal resource FLS increased the proportion of DXA-investigated patients after fracture from 7.6 to 39.6 % (p < 0.001) and the treatment rate after fracture from 12.6 to 31.8 %, which is well in line with FLS types using the conventional coordinator model. Treated patients had a 51 % lower risk of any re-fracture than untreated patients (HR 0.49, 95 % CI 0.37-0.65 p < 0.001).

Conclusions: We found that our minimal resource FLS was effective in increasing investigation and treatment, in line with conventional coordinator-based services, and that treated patients had a 51 % reduced risk of new fractures, indicating that also non-coordinator based fracture liaison services can improve secondary prevention of fractures.

Keywords: Efficiency; FLS; Fracture; Fracture liaison service; Osteoporosis.

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Conflict of interest statement

Compliance with ethical standardsThe study was approved by the regional ethical review board in Gothenburg.Conflicts of interestNone.Funding sourcesThis study was funded by the research fund at Skaraborg Hospital Skövde, Sweden, the Swedish Research Council (VR), the Gothenburg Society of Medicine (GLS), the ALF/LUA grant from the Sahlgrenska University Hospital and Gustaf V:s och Drottning Victorias Frimurarstiftelse.

Figures

Fig. 1
Fig. 1
Follow-up after index fracture. Periods 2011–2012 (no FLS) versus 2013–2014 (FLS). a DXA examination, b pharmacological treatment. Adjusted for age and sex
Fig. 2
Fig. 2
Cumulative incidence of any re-fracture. Period 2011–2014. Non-treated versus treated. Adjusted for age, sex, previous fracture, previous osteoporosis, previous treatment, Charlson comorbidity index, secondary osteoporosis according to FRAX, rheumatoid arthritis and type of index fracture
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