Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Selecting for older patients at higher fracture risk increases treatment efficiency in a hospital-based osteoporosis fracture liaison service (#323)

Shejil Kumar 1 2 , Lillias Nairn 3 , Angela Bowman 4 , Sally Dwyer 3 , Matti L Gild 1 2 , Christian M Girgis 1 2 , Lyn March 2 5 , Roderick J Clifton-Bligh 1 2
  1. Endocrinology Department, Royal North Shore Hospital, Sydney
  2. Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  3. Physiotherapy Department, Royal North Shore Hospital, Sydney, NSW, Australia
  4. Geriatrics Department, Logan Hospital, Meadowbrook, Queensland, Australia
  5. Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia

Aims: It is uncertain whether increasing uptake of hospital-based fracture liaison services (FLS) leads to more cost-effective secondary fracture prevention. Selecting for patients at higher fracture risk may optimise resource allocation and cost-effectiveness of hospital-based FLS.

Methods: Prospectively collected data were reviewed for patients assessed in the FLS at Royal North Shore Hospital, Sydney from December 2015-July 2023. Patients with recent fracture were identified via an electronic search tool and/or service referral. Initial assessment was conducted by an FLS coordinator prior to independent clinician review. In April 2018, the patient selection strategy was re-calibrated, with those ≥60 years old presenting with hip and/or vertebral fractures preferentially invited to attend. The cohorts entering the service pre-(FLS1) and post-(FLS2) this timepoint were compared regarding clinical characteristics and treatment recommendations using Chi-square test (categorical variables) and independent samples t-test or Mann-Whitney U test (continuous variables).

Results: The total cohort (n=2,141) had mean (SD) age 69±11-years. Patients were predominantly female (78%) in whom median(IQR) menopausal age was 50(48-52)-years. Both cohorts were similar in sex, BMI, and prevalence of smoking history, excess alcohol intake, parental hip fracture and vitamin D deficiency. The FLS2 cohort were older (71(63-78) years vs 65(58-74) years, p<0.001), had more frequent ever-prednisone use (8.9% vs 4.6%, p=0.003), more likely to present with hip/vertebral fracture (23.4% vs 14.4%, p<0.001), and higher 10-year Garvan-calculated risk of fragility fracture (36.6%(23.0-55.0%) vs 27.9%(17.2-40.2%), p<0.001) and hip fracture (12.0%(4.8-27.0%) vs 7.2%(3.1-15.0%), p<0.001). The FLS2 cohort were more likely to be recommended pharmacotherapy (81.9% vs 67.1%, p<0.001), most commonly denosumab (32.5%), oral bisphosphonates (23.9%) or zoledronic acid (23.0%).

Conclusion: In this hospital-based FLS, re-calibrating patient selection towards a higher fracture risk was associated with greater likelihood of pharmacotherapy being recommended. Further assessment of refracture rates and cost-effectiveness may demonstrate a feasible and more effective hospital-based FLS strategy.

  1. Le HV, Van BW, Shahzad H, Teng P, Punatar N, Agrawal G, Wise B. Fracture liaison service-a multidisciplinary approach to osteoporosis management. Osteoporos Int. 2024. doi: 10.1007/s00198-024-07181-7.
  2. Briot K. Fracture Liaison Services. Curr Opin Rheumatol. 2017;29(4):416-421. doi: 10.1097/BOR.0000000000000401.
  3. Jones AR, Currie D, Peng C, Ebeling PR, Center JR, Duque G, Lybrand S, Lyubomirsky G, Mitchell RJ, Pearson S, Seibel MJ, Occhipinti JA. Expanding access to fracture liaison services in Australia for people with minimal trauma fractures: a system dynamics modelling study. Med J Aust. 2024;220(5):243-248. doi: 10.5694/mja2.52241.