- Title
- Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate
- Creator
- Nakayama, A.; Major, G.; Holliday, E.; Attia, J.; Bogduk, N.
- Relation
- Osteoporosis International Vol. 27, Issue 3, p. 873-879
- Publisher Link
- http://dx.doi.org/10.1007/s00198-015-3443-0
- Publisher
- Springer
- Resource Type
- journal article
- Date
- 2016
- Description
- Summary: We assessed the ability of a fracture liaison service (FLS) to directly reduce re-fracture risk. Having a FLS is associated with a ~40 % reduction in the 3-year risk of major bone and ~30 % of any bone re-fracture. The number needed to treat to prevent a re-fracture is 20. Introduction: FLS have been promoted as the most effective interventions for secondary fracture prevention, and while there is evidence of increased rate of investigation and treatment at institutions with a FLS, only a few studies have considered fracture outcomes directly. We therefore sought to evaluate the ability of our FLS to reduce re-fracture risk. Methods: Historical cohort study of all patients ≥50 years presenting over a 6-month period with a minimal trauma fracture (MTF) to the emergency departments of a tertiary hospital with a FLS, and one without a FLS. Baseline characteristics, mortality and MTFs over a 3-year follow-up were recorded. Results: Five hundred fifteen patients at the FLS hospital and 416 patients at the non-FLS hospital were studied. Over 3 years, 63/515 (12 %) patients at the FLS hospital and 70/416 (17 %) at the non-FLS hospital had a MTF. All patients were analysed in an intention-to-treat analysis regardless of whether they were seen in the FLS follow-up clinic. Statistical analysis using Cox proportional hazard models in the presence of a competing risk of death from any cause was used. After adjustment for baseline characteristics, there was a ~30 % reduction in rate of any re-fracture at the FLS hospital (hazard ratio (HR) 0.67, confidence interval (CI) 0.47-0.95, p value 0.025) and a ~40 % reduction in major re-fractures (hip, spine, femur, pelvis or humerus) (HR 0.59, CI 0.39-0.90, p value 0.013). Conclusions: We found a ~30 % reduction in any re-fractures and a ~40 % reduction in major re-fractures at the FLS hospital compared with a similar non-FLS hospital. The number of patients needed to treat to prevent one new fracture over 3 years is 20.
- Subject
- bone; fracture liaison service; fractures; osteoporosis; secondary prevention
- Identifier
- http://hdl.handle.net/1959.13/1328492
- Identifier
- uon:25921
- Identifier
- ISSN:0937-941X
- Rights
- This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Language
- eng
- Full Text
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