Risk stratification improves outcomes in an osteoporosis fracture liaison service
Abstract
Selecting patients at higher baseline risk of fragility fracture may optimise clinical outcomes and cost-effectiveness of hospital fracture liaison services (FLS). In this cohort study, we found a risk-stratified approach led to a higher rate of treatment initiation and estimated number of fractures prevented compared to the traditional FLS strategy.
Purpose: Hospital-based fracture liaison services (FLS) are cost-effective and reduce refracture risk. However, optimal FLS characteristics to maximise clinical and cost-effectiveness are uncertain.
Methods: We reviewed data for FLS patients at Royal North Shore Hospital, Sydney (2015-2023). In 2018, the patient selection strategy was adjusted from a traditional approach (any fragility fracture, ≥ 50 years) to preferentially invite those either ≥ 60 years with any fragility fracture, or any presenting with hip and/or vertebral fractures. Cohorts entering the service pre-(FLS1) and post-this timepoint (FLS2) were compared regarding clinical characteristics, estimated fracture risk and pharmacotherapy initiation. Modelling was performed to estimate fractures averted.
Results: The total cohort (n = 1903) was median 68-years-old and predominantly female (77%). Both cohorts were similar in sex distribution and prevalence of various fracture risk factors. The FLS2 cohort was older (median 69 vs 65 years, p < 0.001), more frequently presented with hip/vertebral fracture (21.4% vs 13.8%, p < 0.001), had higher Garvan-estimated 10-year…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,903 participants or records.
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