Refracture following Fracture Liaison Service Assessment Illustrates the Requirement for Integrated Falls and Fracture Services

Abstract

The Fracture Liaison Service (FLS) allows appropriate antiosteoporosis therapy to be targeted to potentially reduce future fracture risk. A proportion of these treated patients will still experience a further fracture. This work reviews the characteristics of these patients. Data were collated for patients >65 years old presenting to the South Glasgow FLS between January 2001 and August 2004. There were 2,489 patients who presented (incident fracture group), and 129 (5.2%) sustained an additional fracture (refracture group). Median age of the incident fracture group was 77.8 years vs. 80.6 years for the refracture group (P = nonsignificant). The refracture group was determined according to whether their incident fracture was hip (n = 47) or nonhip (n = 82). When the incident fracture was hip, a refracture was more likely to be a further hip fracture (chi(2) = 14.4, P = 0.002) and patients refractured sooner (median time to refracture 194 [range 10-1,134] days vs. 258 [range 6-1,081] days [nonhip]) (P = nonsignificant). In the refracture group, 76% of patients were already on osteoporosis treatment after their incident fracture. Patients over 65 years of age presenting to FLS who sustain an additional fracture are older; are likely to sustain another hip fracture after an incident hip fracture; often refracture early, particularly when the incident fracture is of the hip; and are often already on antiosteoporosis treatment. Therefore, it is important to identify these high-risk patients and offer a combined approach of prompt drug treatment through a systematic and specialist osteoporosis management team along with reducing any reversible falls risk factors.

Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England

“…119 In the present analysis, 35% and 63% of second hip fractures within 2 years occurred within the first 6 and 12 months, respectively. This is consistent with the clinical audit of the FLS programme at Glasgow, 127 and an extraordinarily high risk of early second hip fracture in a large Danish study. 128 The high rate of early refracture combined with the delayed onset of fracture risk reduction associated with therapies recommended or dispensed within the orthogeriatric and FLS models of care studied here may have contributed to our finding of no impact on refracture risk.…”

Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study

“…The results indicate that early intervention after an index fracture significantly reduces the frequency of subsequent fractures and hence disease burden. The overall refracture rate in the MTF group is similar to the 5.2% refracture rate reported in a dedicated fracture liaison program in Scotland [47], although this latter study had no control group to which refracture rates could have been compared. Our refracture rate without intervention of 19.7% over 4 years is comparable to a refracture rate of 19.4% over the same time interval reported by Johnell et al [49], indicating our control data is comparable to that seen elsewhere.…”

“…However, as shown in Table 1, there were more patients with incident hip fractures in the MTF than in the control group, while the proportion of patients with wrist fractures was similar in both groups. Previous studies indicate that among survivors of an initial hip fracture the risk of a subsequent hip fracture is significantly increased [46,47]. In contrast, the 10-year risk of refracture in patients with an initial wrist facture was found to be lower than that following other osteoporotic fractures [48].…”

Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients

“…For example, eligibility for investigation and treatment varied between studies. Despite including similar fracture populations, Langridge et al [29] offered BMD testing to patients only if it was thought the results would influence the patient's use of OP medication; Blonk et al [31] only advised drug therapy for those patients with OP on BMD; and Streeten et al [20] recommended a bisphosphonate to all patients unless contraindicated. In part, this heterogeneity was probably due to differences in guidelines across the 11 countries represented in this review regarding BMD T-scores and treatment.…”