Background Our fracture liaison service (FLS) for outpatients has reported to maintain 73% of the patients on antiresorptive 2 years after the fracture. For hip fracture we are concerned about the low capture rate (27%).
Objectives To analyze the efectiveness of a FLS for inpatients with hip fracture compared with standard care.
Methods Observational study carried out in two hospitals, one with a FLS (Hospital Negrin) and the other one with standard orthogeriatric care (Hospital Candelaria). The reference population >65 y from H.Negrin and H.Candelaria are 63,382 and 63,249 inhabitants respectively.
We included patient >65 y with fragility hip fracture ocurred between 1th March 2016 and 31th July 2016. Severe dementia, non-fragility fractures and those patients who died during hospital admittance were excluded. All patients underwent hemogram and biochemistry. The densitometry was not performed on any patient. The only difference between hospitals was a dedicated nurse from the FLS H.Negrin who visited inpatients twice a week, interviewed patients, gave education and applied a treatment protocol to be started by Primary Care.
Data recorded were: age, sex, previous fractures and previous treatment for osteoporosis, including calcium, vitamin D, bisphosphonates, denosumab and teriparatide. We also collected the treatment that was included in the discharge report and treatment six month later (checking the electronic prescription).
Results We included 185 patients (105 from Hospital Candelaria and 80 from Hospital Negrin), mean age 82 y (Table). The percentage of patients receiving a bisphosphonate or equivalent before hospital admittance was similar in both hospitals. However, the percentage after discharge rose by 91% in the hospital with FLS and remain 8% in the hospital with standard care. After six months, 75% of patients from FLS and 15% of patients with standard care had a treatment.
Conclusions The implementation of an orthogeriatric FLS lead to an increase in treatment for osteoporosis compared with standard care and similar to our outpatient FLS model. The ideal approach to secondary fracture prevention is a FLS model of care in an integrated health care network, overseen by a nurse coordinator.
Naranjo A et al. Osteoporos Int. 2015;11:2579–85.
Disclosure of Interest None declared