Fracture liaison services improve outcomes in patients with osteoporosis-related fracture history
Fracture liaison services (FLS) improved outcomes in older individuals with a history of osteoporosis-related fractures, according to a systematic review and meta-analysis.
“[FLS] are co-ordinator-based models of secondary fracture prevention services,” said study author Dr Paulo Wu Chih-Hsing from the National Cheng Kung University College of Medicine and Hospital in Tainan, Taiwan, and colleagues.
“[FLS] are designed to identify patients who are considered to be at increased risk of subsequent or secondary fractures, and, following a comprehensive assessment, ensure that patients initiate appropriate treatment via improved care co-ordination and communication,” he said.
Compared with non-FLS controls, individuals who used FLS demonstrated reductions in the absolute risk of refracture (unweighted average refracture rate, 13.4 percent [non-FLS] vs 6.4 percent [FLS]) and absolute risk of mortality (unweighted average mortality rate, 15.8 percent vs 10.4 percent). [AFOS 2017, abstract PC 26]
Individuals using FLS also demonstrated increases in the rates of bone mineral density (BMD) testing (unweighted average rate, 23.5 percent [non-FLS] vs 48.1 percent [FLS]), treatment initiation (unweighted average rate, 17.2 percent vs 38.0 percent), and treatment adherence (unweighted average rate, 34.1 percent vs 57.0 percent).
The findings were presented as a poster at the 5th Scientific Meeting of the Asian Federation of Osteoporosis Societies (AFOS 2017), held recently in Kuala Lumpur, Malaysia.
Studies included in the analyses were limited to 74 randomized and non-randomized trials, and retrospective and prospective observational studies, with studies on primary fracture prevention and other bone diseases excluded. Study participants were age ≥50 years with previous osteoporosis-related fractures.
The observational nature of many included studies as well as variations in baseline characteristics among the patients may have affected the results, said the researchers. Moreover, a majority of the studies were conducted in Western populations, limiting the generalizability of the data, they said, calling for further research in non-Western populations as well as studies evaluating long-term outcomes of FLS.
“The results of our systematic literature review and meta-analysis suggest that FLS programmes have improved the management of osteoporosis, resulting in significant reductions in refracture and mortality rates and significant increases in BMD testing, treatment initiation rates, and adherence,” said Wu and co-authors.
“FLS are clinically effective across a range of clinically important outcomes in patients with osteoporosis, therefore indicating that FLS play a significant role in minimizing the burden of osteoporosis,” they said.