Background Osteoporotic fractures impose a significant morbidity, mortality and economic burden (1). Research within our hospital confirmed low rates of identification and secondary prevention for patients discharged from Emergency Department (ED) with a fracture (2). The Fracture Liaison Service (FLS) aimed to identify, review and then manage these patients following their discharge from the ED.
Objectives To evaluate the performance of a FLS in a Western Australian hospital.
Methods Patients aged >50 yrs who presented to the Emergency Department after a fracture at Sir Charles Gairdner Hospital (SCGH) were invited to the FLS. A retrospective control group from SCGH determined the historical fracture risk without an active FLS intervention. Fremantle Hospital was used as a prospective control cohort.
Demographic data was collected at baseline then patients were followed up at 3 & 12 months. The follow-up survey collected information on: awareness of osteoporosis, investigations undertaken (e.g. BMD testing), had a diagnosis been made, medication usage, health care utilisation, falls & fracture information and quality of life (EQ-5D).
Results The FLS reduced the recurrence of minimal trauma fractures over 12 months by between 9.2 to 10.2% compared to a retrospective cohort & a prospective control cohort. 167 or 69.3% of eligible patients agreed to attend the Fragile Bone Clinic. As the program becomes more main-stream the utilisation of the service is expected to increase.
The FLS demonstrated a 17.1% increase in patient awareness of osteoporosis compared to other sites and by 35.6% compared to the SCGH retrospective group over 12 months (p<0.001). The FLS had better prescription rates of calcium (57.4% vs 28.8%), vitamin D (59.8% vs 33.0%), optimised calcium & vitamin D (48.4% vs 19.8%) and anti-resorptive therapy (29.9% vs 16.2%) compared to the retrospective cohort at SCGH. At 12 months the FLS had the highest number (n=82) and rate (46.9%) of patients initiated on pharmacological treatment compared to other sites 17 (41.5%) and SCGH Retrospective 12 (16.0%). The FLS incrementally improved the prescription, adherence and compliance with of osteoporosis treatment.
Conclusions By 12 months the Fracture Liaison Service demonstrated that it reduced the recurrent fracture rate and significantly improved rates of pharmacological treatment initiation & patient awareness of osteoporosis.
Briggs AM et al. (2015) Hospitalisations, admission costs and re-fracture risk related to osteoporosis in Western Australia are substantial: a 10-year review. ANZ J Public Health.
Inderjeeth CA et al. (2010) A multimodal intervention to improve fragility fracture management in patients presenting to Emergency Departments. MJA
Disclosure of Interest None declared