Background A Geriatric Trauma Unit (GTU) was created in our hospital to optimize the acute treatment of patients with fragility fractures. The rheumatology department assists in subsequente evaluation of these.
Objectives To report the results of the evaluation after 10 months of a fracture liaison service (FLS).
Methods All patients over 65 years-old admitted to the GTU with a fragility hip fracture were systematically identified on a daily, prospective basis. The protocol was first implemented on March 2015 and we describe all patients included until December 2015. After a first evaluation during the hospital admission, patients are referred to the outpatient clinic for further characterization, generally within 3 months. The investigations included were dual-energy x-ray absortiometry (DXA, GE-Lunar), FRAX® including DXA and laboratory blood tests. A descriptive study was performed.
Results 208 cases of fragility hip fracture in patients above 65 years were identified, 78.9% women. Mean age (sd) of 83 years old (7.6). The most frequently affected segment of the hip was the trochanteric region (n=109, 52.4%), followed by the femoral neck (n=75, 36.1%). Most patients (68.8%) underwent surgical intervention within the first 48 hours. Regarding risk factors for osteoporosis (OP), there was a high prevalence of selective serotonin reuptake inhibitor consumption (n=40, 20.1%) as well as antiepileptics (n=10, 5%) and corticosteroids (n=9, 4.5%). Another highly prevalent risk factor was diabetes (n=49, 23.5%). Regarding the body mass index we found that the majority of patients (42.3%) had values within normal limits. Benzodiazepines use, clearly associated with falls, was reported by 44% of patients (n=91). In our analysis only 13.5% (n=28) of the patients had past or current use of bisphosphonates (BP) and only 5.8% of those reporting previous fragility fracture were ever treated for OP. The prevalence of previous fragility fracture was 25.3% (n=47), most commonly hip fracture (n=19, 10.2%). Prior to fracture, 62.5% of patients were independent for daily activities. However, within 3 months after the fracture, only 32% of these patients regain their autonomy. We have recorded 22 deaths, 12 cases during hospitalization.
Full assessment of bone health was conducted in 44 patients. In 34% (15/44) of the cases, the densitometric criteria for OP were not met and 20 (45.5%) patients had radiographic signs of vertebral fragility fracture. Only 9 patients had 25-OH vitamin D levels above 30 ng/mL and 19 (43%) patients had deficiency levels. Using the FRAX toll, the absolute risk of major osteoporotic fracture was higher than 20% in 8 (18%) patients and the absolute risk of hip fracture was higher than 3% in 30 (68%) patients. Regarding treatment implementation, all patients received calcium and vitamin D supplementation and 35 (84%) patients started anti-osteoporotic treatment (33 BP and 2 denosumab).
Conclusions FLS are key pieces in the secondary fracture prevention as they facilitate patient care by automatically including all patients with a fragility fracture within a health-care system able to implement the adequate strategies to prevent future fractures as well as fracture-related complications.
Disclosure of Interest None declared
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