Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards

Abstract

Summary REFRA-FLS is a new registry in Spain aimed at identifying individuals over 50 years of age with a fragility fracture. Using this registry, we found hip fracture is the most prevalent fracture. Treatment for osteoporosis was 87.7%, with 65.3% adherence. REFRA-FLS provides fundamental data in the study of fragility fractures. Purpose Fragility fractures are a growing public health concern in modern-aged societies. Fracture Liaison Services (FLS) have been shown to successfully lower rates of secondary fractures. A new registry (REFRA-FLS) has been created to monitor quality indicators of FLS units in Spain and to explore the occurrence and characteristic of fragility fractures identified by these centers. Methods We conducted a prospective cohort study based on fragility fractures recorded in the REFRA-FLS registry. Participants were individuals 50 years or above who suffered a low energy fragility fracture identified by the 10 participating FLS units during the study period. The type of FLS unit, the characteristics of the individuals at baseline, along with patient outcomes as quality indicators among those who completed 1 year of follow-up were analyzed. Results A total of 2965 patients and 3067 fragility fractures were identified, and the most frequent locations were hip (n = 1709, 55.7%) and spine (n = 492, 16.0%). A total of 43 refractures (4.5%) and 46 deaths (4.9%) were observed among 948 individuals in the follow-up analyses. Time from fracture to evaluation was less than 3 months in 76.7% of individuals. Osteoporosis treatment was prescribed in 87.7%, and adherence was 65.3% in Morisky–Green test. Conclusion Our results provide a comprehensive picture of fragility fractures identified in FLS units from Spain. Overall, quality indicators are satisfactory although a much higher use of DXA would be desirable. As the registry grows with the incorporation of new FLS units and longer follow-up, incoming analyses will provide valuable insight.

Team Approach: Organizing and Empowering Multidisciplinary Teams in Postfragility Fracture Care

“…Finally, it was noted that lack of patient understanding of osteoporosis negatively affected primary care visit attendance. In addition, in a report of the outcomes of a national PFCP in Spain managed by the Spanish Society for Bone and Mineral Research, the authors note that a substantive area for future improvement was improving communication between the FLS and primary care centers 9 .…”

“…The program's structure emphasizes identification of inpatients with fragility fracture, coordination between inpatient FLS units and primary care providers, and quarterly meetings with FLS coordinators to review performance from all sites. In a report on the first 10 program sites 9 , patient enrollment averaged approximately 2.5 patients per day, and approximately 65% of patients enrolled adhered to treatment recommendations at 1 year of follow-up. The authors note that an area for future improvement was further improving communication between the FLS and primary care providers.…”