ObjectivesThe purpose of the study was to assess the effectiveness of the Fracture Liaison service (FLS) in preventing secondary fracture and decreasing 1-year mortality rate after osteoporotic hip fracture, in patients at Police General Hospital, Bangkok, Thailand.MethodsA prospective cohort study was conducted. We studied male and female patients, 50 years of age and older, who presented with a fragility fracture around the hip due to low energy trauma and were admitted to Police General Hospital, participating in PGH's Liaison service from April 1, 2014–March 30, 2015. The sample size was 75 patients, with a follow up time of 1 year. The data from this study was compared with that of a previous study done by Tanawat A. et al. [9] prior to commencement of the FLS project.ResultsAfter a follow up period of 1 year, the mortality rate was measured to be 10.7% and there was no evidence of secondary fragility fracture. Post-injury bone mineral density follow up and osteoporotic medication treatment rates were 48% and 80%, respectively. Patients who participated in the project were found to have a decreasing rate of secondary fracture from 30% to 0% (P < 0.0001), an increasing post-injury BMD follow up rate from 28.3% to 48% (P = 0.0053), and an increase in post-injury osteoporotic medication administration rate from 40.8% to 80% (P = 0.0148), all with statistical significance. However, the 1-year mortality rate was not significant (P = 0.731) when compared to the previous study.ConclusionsPatients with recent hip fractures participating in the Fracture Liaison service had a significantly higher post-injury BMD follow up and osteoporotic medication administration rates. This resulted in a lower risk of secondary fracture than those who did not participate in the Fracture Liaison service at a follow up time of one year.

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Background: Vitamin D deficiency directly impacts bone biology, eventually resulting in elevated risk of fragility fracture. Despite its global abundance, data concerning its prevalence and risk factors among Thai patients with osteoporotic hip fractures remains lacking. Objectives: This study aimed to evaluate the average level of serum vitamin D, prevalence of hypovitaminosis D and its risk factor among Thai elderly patients with fragility hip fractures. Methods: A cross-sectional study was conducted among Thai patients with fragility hip fractures aged 60 years or older in a single center from April 2016-April 2020. The patients were divided according to serum 25-hydroxy vitamin D (25-(OH)D) levels. Demographic data were compared to identify risk factors of vitamin D inadequacy. Results: Of 258 patients, 74.81% were females with mean age of 78.76 years. The average serum 25(OH)D level was 19.64 ng/mL. Prevalences of vitamin D inadequacy, vitamin D insufficiency and vitamin D deficiency were 86.05, 28.69 and 57.36%, respectively. When compared with the vitamin D sufficiency group, the vitamin D inadequacy group had a history of frequent falls, higher body mass index (BMI) as well as high parathyroid hormone (PTH) levels.  Risk factors associated with vitamin D inadequacy were BMI >23 kg/m2 (AOR= 4.67, 95%CI=1.24-17.73), and two or more falls within a year (AOR= 3.96, 95%CI=1.38-11.33). Moreover, risk factors associated with vitamin D deficiency were being female (AOR= 2.87, 95%CI=1.06-7.78), BMI >23 kg/m (AOR=7.20, 95%CI =1.67-31.02), two or more falls within one year (AOR=7.32, 95%CI =2.17-24.69) and elevated PTH level (AOR= 3.38, 95%CI=1.17-0.74). Conclusion: Most elderly patients with fragility hip fractures had hypovitaminosis D. Risk factors included high BMI, frequent falls for vitamin D inadequacy, being female and high PTH levels for vitamin D deficiency. Serum 25(OH)D assessment and appropriate supplement are recommended, especially for patients with fragility hip fractures and aforementioned risk factors.

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Purpose: The Fracture Risk Assessment Tool (FRAX®) has been recommended and incorporated into osteoporotic guidelines worldwide to assess fracture risk and promptly diagnose osteoporosis when bone mineral density is unavailable. However, a country-specific intervention threshold for Thai patients remains unknown. Therefore, we aimed to identify an appropriate cut-off point for the 10-year probability of hip fracture (HF), specifically in the Thai population. Methods: This retrospective cohort study included members of the Thai population aged 50-90 years, enrolled from January 2018 to January 2020. Analysis of data collected from online FRAX® tool questionnaires was conducted and the receiver operating characteristic (ROC) curve was used to determine a new appropriate cut-off value as the intervention threshold. Results: A total of 1,311 (HF: 422 [32.2%], non-HF: 889 [67.8%]) participants were included. The FRAX® 10-year probability of fracture in patients with HF was significantly higher than in non-HF (5.8% ± 4% vs. 4.7% ± 4.5%, respectively; P < 0.01), whereas the probability of major osteoporotic fracture (MOF) was similar (11.0 ± 5.8% vs. 10.6 ± 6.2%, P = 0.27). The ROC curve revealed a new intervention threshold for the FRAX®-based 10-year risk for HF of 4.3% with a maximum area under the curve (AUC) (95% confidence interval: 0.632 (range: 0.602-0.663; P < 0.001), with sensitivity and specificity of 62.9% and 60.7%, respectively. Conclusions: The intervention threshold cut-off value for osteoporosis treatment among the Thai population was 4.3%, which is higher than the cut-off point recommended in the Thai national guidelines.

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