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Fracture liaison services confer benefit on recurrent fracture risk 

Key clinical point: The implementation of fracture liaison services was associated with a reduced risk of recurrent fracture.

Major finding: Patients with a major bone fracture at two Swedish hospitals during a fracture liaison services period had 18% reduced risk of recurrent fracture, compared with patients in the period prior to the fracture liaison services implementation.

Study details: An observational cohort study of 21,083 patients from four hospitals in Sweden.

Disclosures: Dr. Axelsson reported that he has received lecture fees from Lilly, Meda/Mylan, and Amgen. Dr. Lorentzon has received lecture fees from Amgen, Lilly, UCB, Radius Health, Meda, GE-Lunar, and Santax Medico/Hologic. The other coauthors reported having no financial disclosures. Dr. Silverman reported that he is a member of the speakers’ bureaus for Amgen and Radius. He is also a consultant for Lilly, Pfizer, and Amgen and has received research grants from Radius and Amgen.

Commentary

“National and international professional societies recommend the use of fracture liaison services (FLS) to coordinate care for patients with fragility fracture. This retrospective cohort study conducted in Sweden examined temporal trends in recurrent fracture rates among 21,083 patients aged 50 years and older with major osteoporotic fractures (MOF) identified from electronic health records at four hospitals, two of which implemented FLS during the study period. Patient characteristics at the time of index fracture were similar between patients enrolled before/after FLS and between FLS/non-FLS hospitals. At the two hospital that implemented FLS, the risk of recurrent MOF was 18% lower in the FLS period compared with the period before implementation (HR = 0.82, 95% CI 0.73–0.93, p < 0.001) and association that remained even after accounting for covariates (e.g. age, sex, comorbidities) and competing risk of death (HR = 0.73, 95%CI 0.66–0.82, p < 0.001). In the FLS hospitals osteoporosis treatment rates within 1 year after index fracture increased significantly from 14.7% to 28.0% (p < 0.001) after FLS implementation. The findings from this study add to the body of literature supporting the notion that care coordination post MOF using FLS is associated with decrease rate of recurrent MOF.”

Maria I. Danila, MD, MSc, MSPH

University of Alabama at Birmingham

Citation:

Axelsson K et al. J Bone Min Res. 2020 Feb 25.