A retrospective service evaluation of patient awareness and engagement, and medication compliance and adherence, in patients with opportunistically identified vertebral fragility fractures in a local fracture liaison service

Introduction: Fracture liaison services (FLS), often staffed by radiographers, identify and treat patients over the age of 50 at high risk of future fractures by intervening after the first fracture. Vertebral fragility fractures (VFF) are particularly disabling and are highly predictive of future fracture but are underdiagnosed as they often do not come to clinical attention. To review the behaviour traits of patient with opportunistically identified VFF's (OIVFF), local FLS data can be used to compare outcomes of OIVFF's with acute VFF's (AVFF) and non-hip/spine fragility fractures (NHSFF).

Methods: A retrospective service evaluation was completed using local FLS data from 1/1/22-31/12/22. A total of 1403 patients' data was included. Data was grouped by fracture cohort to evaluate patient engagement, fracture awareness, medication compliance and adherence.

Results: The OIVFF cohort had the highest proportion of men at 32.4 %. There was little difference in engagement rates between cohorts but fracture awareness was low in the OIVFF cohort. Non-compliance to medication was highest in the NHSFF cohort. The OIVFF cohort had the highest number of patients no longer appropriate for treatment after 12 months (11.29 %). Medication adherence at 12 months was similar across cohorts.

Conclusion: Patients with OIVFF's do not appear to behave differently to other symptomatic fracture types within the FLS pathway in terms of engagement, compliance or adherence.

Implications for practice: Awareness of fracture was low for VFF's and future improvement of the patient diagnosis communication pathway is recommended. Further research into the increased number of men with OIVFF is recommended to ensure the pathway is efficient and to review potential barriers to diagnosis. Results suggest continued exploration of improving opportunistic identification of vertebral fractures is justified.