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Association between recurrent fracture risk and implementation of fracture liaison services in four Swedish hospitals: A cohort study
Department of Orthopaedic Surgery, Region Västra Götaland, Skaraborg Hospital, Skövde, Sweden.
Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.ORCID iD: 0000-0002-6549-086x
Region Västra Götaland, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
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2020 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 35, no 7, p. 1216-1223Article in journal (Refereed) Published
Abstract [en]

Structured secondary preventions programs, called fracture liaison services (FLSs), increase the rate of evaluation with bone densitometry and use of osteoporosis medication after fracture. However, the evidence regarding the effect on the risk of recurrent fracture is insufficient. The aim of this study was to investigate if implementation of FLS was associated with reduced risk of recurrent fractures. In this retrospective cohort study, electronic health records during 2012 to 2017 were used to identify a total of 21,083 patients from four hospitals in Western Sweden, two with FLS (n = 15,449) and two without (n = 5634). All patients aged 50 years or older (mean age 73.9 [SD 12.4] years, 76% women) with a major osteoporotic index fracture (hip, clinical spine, humerus, radius, and pelvis) were included. The primary outcome was recurrent major osteoporotic fracture. All patients with an index fracture during the FLS period (n = 13,946) were compared with all patients in the period before FLS implementation (n = 7137) in an intention-to-treat analysis. Time periods corresponding to the FLS hospitals were used for the non-FLS hospitals. In the hospitals with FLSs, there were 1247 recurrent fractures during a median follow-up time of 2.2 years (range 0–6 years). In an unadjusted Cox model, the risk of recurrent fracture was 18% lower in the FLS period compared with the control period (hazard ratio = 0.82, 95% confidence interval [CI] 0.73–0.92, p = 0.001), corresponding to a 3-year number needed to screen of 61, and did not change after adjustment for clinical risk factors. In the hospitals without FLSs, no change in recurrent fracture rate was observed. Treatment decisions were made according to the Swedish treatment guidelines. In conclusion, implementation of FLS was associated with a reduced risk of recurrent fracture, indicating that FLSs should be included routinely at hospitals treating fracture patients. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2020. Vol. 35, no 7, p. 1216-1223
Keywords [en]
Fracture, Fracture Liaison Service, Osteoporosis, Recurrent Fracture
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:hj:diva-48204DOI: 10.1002/jbmr.3990ISI: 000547662100003PubMedID: 32097504Scopus ID: 2-s2.0-85082142028Local ID: HOA HHH 2020;HHJÖvrigtISOAI: oai:DiVA.org:hj-48204DiVA, id: diva2:1426227
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Swedish Research Council, 2017‐02229Available from: 2020-04-24 Created: 2020-04-24 Last updated: 2021-01-27Bibliographically approved

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Lundh, Dan

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