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. 2022 Oct;37(10):2025-2032.
doi: 10.1002/jbmr.4674. Epub 2022 Sep 10.

Decreased Mortality and Subsequent Fracture Risk in Patients With a Major and Hip Fracture After the Introduction of a Fracture Liaison Service: A 3-Year Follow-Up Survey

Lisanne Vranken  1   2 , Irma J A de Bruin  1   2 , Annemariek H M Driessen  3 , Piet P M Geusens  4   5 , John A Eisman  6   7   8 , Jacqueline R Center  6   7 , Robert Y van der Velde  1   2 , Heinrich M J Janzing  9 , Sjoerd Kaarsemaker  10 , Joop P van den Bergh  1   2 , Caroline E Wyers  1   2
Affiliations

Decreased Mortality and Subsequent Fracture Risk in Patients With a Major and Hip Fracture After the Introduction of a Fracture Liaison Service: A 3-Year Follow-Up Survey

Lisanne Vranken et al. J Bone Miner Res. 2022 Oct.

Abstract

Fracture liaison services (FLS) are considered to be the most effective organizational approach for secondary fracture prevention. In this study, we evaluated whether FLS care was associated with reduced subsequent fracture and mortality risk over 3 years of follow-up. In total, 8682 consecutive patients aged 50-90 years with a recent fracture were included. Before FLS introduction, regular fracture treatment procedures were followed (pre-FLS). After FLS introduction, patients were invited to the FLS and FLS attenders were assessed for osteoporosis, prevalent vertebral fractures, metabolic bone disorders, medication use, and fall risk, and treatment for fracture prevention was initiated according to Dutch guidelines. All fractures were radiographically confirmed and categorized into major/hip (pelvis, proximal humerus or tibia, vertebral, multiple rib, distal femur) and non-major/non-hip (all other fractures). Mortality risk was examined using age and sex adjusted Cox proportional hazard models. For subsequent fracture risk, Cox proportional hazard models were adjusted for age, sex, and competing mortality risk (subdistribution hazard [SHR] approach). The pre-FLS group consisted of 2530 patients (72% women), of whom 1188 (46.9%) had major/hip index fractures, the post-FLS group consisted of 6152 patients (69% women), of whom 2973 (48.3%) had major/hip index fractures. In patients with a non-major/non-hip fracture there was no difference in subsequent non-major/non-hip fracture risk or mortality between pre-FLS and post-FLS. In patients with a major/hip index fracture, mortality risk was lower post-FLS (hazard ratio [HR] 0.84; 95% confidence interval [CI], 0.73-0.96) and subsequent major/hip fracture risk was lower in the first 360 days after index fracture post-FLS compared to pre-FLS (SHR 0.67; 95% CI, 0.52-0.87). In conclusion, FLS care was associated with a lower mortality risk in the first 3 years and a lower subsequent major/hip fracture risk in the first year in patients with a major/hip index fracture but not in patients with a non-major/non-hip fracture. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Keywords: AGING; FRACTURE PREVENTION; FRACTURE RISK ASSESSMENT; HEALTH SERVICES RESEARCH; OSTEOPOROSIS.

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Conflict of interest statement

IJAdB: received personal fees from Sanofi and Amgen, outside the submitted work. JAE: has consulted for and/or received research funding from Amgen, deCode, Merck Sharp and Dohme, Sanofi‐Aventis and Theramax outside the submitted work. JRC: advisory boards for Amgen; research funding from Amgen, outside the submitted work. RYvdV: received funding from Novo Nordisk an Lilly, outside the submitted work. JPWvdB: consultant for Amgen and UCB, research funding from Amgen and UCB, outside the submitted work. AHMD, LV, PPMG, JHMD, HMJJ, SK, CEW: no conflicts of interest.

Figures

Fig. 1
Fig. 1
Mortality risk after a major or hip index fracture during 3 years of follow‐up, starting from date of index fracture.
Fig. 2
Fig. 2
Subsequent major or hip fracture risk after a major or hip index fracture during 3 years of follow‐up, starting from date of index fracture.
See this image and copyright information in PMC

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