For patients with fragility fractures related to underlying bone weakness, a dedicated fracture liaison service (FLS) can lower the risk of subsequent fractures, suggests a study in the March 18, 2020 issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.
Patients receiving FLS care have high rates of evaluation and treatment for osteoporosis, leading to improved bone quality and function, according to the follow-up study by Julio C. Fernandes, MD, FRCSC, PhD, MBA, and colleagues of Université de Montréal. "These results suggest that an intensive FLS model of care, with a systematic longitudinal follow-up, is effective," the researchers write.
New data on two-year outcomes of FLS care for fragility fractures
Fragility fractures are those resulting from minimal trauma, such as a fall from standing height or less, and commonly occur in the hip, spine, or wrist. The FLS approach has emerged as a means to improve the identification and care of fragility fractures, including those related to osteoporosis.
Dr. Fernandes and colleagues report on their experience with FLS care in 532 patients. The average patient age was 63 years, and 86 percent were women. Rates of recommended evaluation and management of fragility fractures were analyzed, along with subsequent fractures and other key outcomes after a two-year follow-up.
Patients managed with use of FLS had high rates of recommended care. Eighty-nine percent of patients underwent measurement of bone mineral density, and 87 percent were started on treatment for osteoporosis. Overall, 84 percent of patients made at least one follow-up visit.
A total of 23 subsequent fractures occurred in 21 patients over nearly 900 person-years, with a rate of 2.6 percent per 100 person-years. That rate was lower than those suggested by past studies of patients with fragility fractures in the general population, which have ranged from 4 to 10 per 100 person-years.
Laboratory tests showed significant improvements bone metabolism during FLS care, including a slower rate of bone turnover. Standard measures of functional capacity and disability improved, while pain scores decreased.
Despite its growing popularity, there are still limited data on the effectiveness of the FLS approach. While previous "real world" studies of FLS care have reported high rates of testing and treatment, this new study is one of the first to include the results of systematic follow-up, including subsequent fracture rates.
The results suggest real benefits of FLS care for patients with fragility fractures, including testing, treatment, and follow-up participation rates over 80 percent. This study also suggests that FLS care is associated with a low rate of subsequent fractures, with reduced bone turnover and improved functional capacity.
Although this new analysis doesn't include a comparison group of patients not receiving FLS care, historical data from previous studies support their findings.
A randomized controlled trial with a larger sample and a longer follow-up period would better quantify the yield of improvement over the usual care."
Dr. Fernandes and colleagues
Senay, A., et al. (2020) Performance of a Fracture Liaison Service in an Orthopaedic Setting, A Report of Key Indicators and Improvement of Longitudinal Outcomes. The Journal of Bone and Joint Surgery. doi.org/10.2106/JBJS.19.00185.