The impact of a fracture liaison service with in-hospital anti-osteoporosis treatment on subsequent hip fracture and mortality rates-a single-center retrospective study

Abstract

The implementation of an in-hospital fracture liaison service facilitated prompt initiation of anti-osteoporosis treatment following a hip fracture (HF), increasing follow-up and treatment rates. This led to a 48% reduction in the risk of subsequent HF and a 29% decrease in mortality rates.

Purpose: To demonstrate the impact of an institutional fracture liaison service (FLS) which allowed in-hospital anti-osteoporosis treatment following hip fracture (HF) on subsequent HF and mortality rate.

Methods: We retrospectively evaluated patients aged 65 years and older, admitted with an osteoporotic HF, who were transferred following surgery for rehabilitation in the geriatrics department in two time periods: before and after the implementation of an institutional FLS ("geriatric-pre-FLS" and "geriatric-FLS" cohorts, respectively). Data were captured from electronic records and the two cohorts were compared following an assessment of baseline characteristics, follow-up, and anti-osteoporosis treatment initiation. A multivariable Cox regression model evaluated differences between the cohorts regarding subsequent HF and mortality rates.

Results: Three hundred and eighteen and 448 patients comprised the geriatric-pre-FLS (07/2008-06/2014) and the geriatric-FLS (03/2016-03/2020) cohorts, respectively. Baseline characteristics were comparable between the cohorts (median age 81 vs. 82, p = 0.08 and female sex 73% vs. 70%, p = 0.48, respectively). Rates of endocrine consultation (3.5% vs. 99%%, p < 0.001), DXA-BMD testing (7.5% vs. 34%, p < 0.001), and parenteral anti-osteoporosis treatment (4% vs. 76.6%, p < 0.001) were all higher in the geriatric-FLS cohort. The implementation of the FLS led to a 48% reduction in subsequent HF risk (HR 0.52; 95% CI 0.37-0.74, p < 0.001) and a 29% decrease in mortality rate (HR 0.71; 95% CI 0.54-0.92, p = 0.011).

Conclusions: The implementation of an in-hospital FLS facilitated prompt initiation of anti-osteoporosis treatment following a HF, increased follow-up and treatment rates, and resulted in a 48% reduction in subsequent HF risk and a 29% reduction in mortality rates.

Keywords: Fracture liaison services (FLS); Hip fracture; Mortality; Osteoporosis; Subsequent hip fracture.

Fig. 1

Study flowchart. ^†These patients were transferred for rehabilitation to other institutions or opted for home rehabilitation and were invited to undergo outpatient evaluation and treatment initiation in the endocrinology clinic

Fig. 2

Kaplan–Meier curve for the primary outcome of subsequent hip fractures in the geriatric-pre-FLS and geriatric-FLS cohorts

Fig. 3

Kaplan–Meier curve for the secondary outcome of mortality rates in the geriatric-pre-FLS and geriatric-FLS cohorts