Secondary prevention of osteoporotic fractures: evaluation of the Lille University Hospital's Fracture Liaison Service between January 2016 and January 2018

Osteoporos Int. 2019 Sep;30(9):1779-1788. doi: 10.1007/s00198-019-05036-0. Epub 2019 Jun 5.

Abstract

The purpose of this study was to assess the performance of our Fracture Liaison Service (FLS) over a period of 2 years. Osteoporosis medication was prescribed for 243 patients, and zoledronic acid was the main drug prescribed (60.2%).

Introduction: A Fracture Liaison Service (FLS) was implemented at Lille University Hospital in 2016. The main purpose of this study was to assess the performance of the FLS using criteria proposed by the International Osteoporosis Foundation (IOF).

Methods: The criteria used were patient identification, patient evaluation, post-fracture assessment timing, vertebral-fracture identification, blood and bone mineral density (BMD) testing, falls prevention, multifaceted health and lifestyle risk-factor assessment, and medication initiation and review.

Results: Between January 2016 and January 2018, 736 patients (≥ 50 years old) with a recent history of fragility fracture (≤ 12 months) were identified. The identification rate for hip fractures was 74.2%. However, patient evaluation for all type of fractures was quite low (30.3%) since many patients failed to attend the FLS unit. The reasons for non-attendance were refusal, agreed but subsequently failed to attend, and still waiting to be seen. In all, 256 patients (76.6% female, mean (SD) age 74.3 (11.0) years) were seen at the FLS. Mean (SD) post-fracture assessment timing was 13.3 (9.3) weeks. Of the 139 patients seen for a non-vertebral fracture, 103 were assessed for vertebral fractures, and at least one new vertebral fracture was found in 45 of them (43.7%). Osteoporosis medication was prescribed for 243 (94.9%) patients. The main osteoporosis drug prescribed was zoledronic acid (60.2%).

Conclusions: Secondary prevention of osteoporotic fractures has improved since the implementation of the FLS. However, patient identification, patient evaluation, and post-fracture assessment timing still need to be improved.

Keywords: Fracture; Fracture liaison service; Hip fracture; Osteoporosis; Vertebral fracture.

MeSH terms

  • Accidental Falls / prevention & control
  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / therapeutic use
  • Communication
  • Critical Pathways / organization & administration
  • Delivery of Health Care, Integrated / organization & administration
  • Delivery of Health Care, Integrated / standards
  • Female
  • France / epidemiology
  • Health Services Research / methods
  • Hospitals, University / organization & administration
  • Hospitals, University / standards
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • No-Show Patients / statistics & numerical data
  • Osteoporosis / drug therapy
  • Osteoporosis / epidemiology
  • Osteoporotic Fractures / epidemiology
  • Osteoporotic Fractures / prevention & control*
  • Quality Indicators, Health Care
  • Retrospective Studies
  • Risk Assessment / methods
  • Secondary Prevention / methods*
  • Secondary Prevention / organization & administration
  • Secondary Prevention / standards

Substances

  • Bone Density Conservation Agents