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Enrollment in a fracture liaison service does not guarantee post fracture follow-up
Craig R Jenkins1, Jessica D Collier1, Claire I Yee1
1Division of Endocrinology (Jenkins, Collier, Whitaker, and Cook), Division of Clinical Trials and Biostatistics (Yee, Langlais, and Quillen), and Enterprise Technology Services (Verona), Mayo Clinic, Scottsdale, AZ, United States.
Objective:
To assess post fracture outpatient follow-up adherence in a cohort of patients enrolled in a fracture liaison service (FLS).
Methods:
We analyzed FLS registry data for patients who were hospitalized with fragility fractures from June 2020 through December 2022 and determined the proportion of patients who kept their follow-up appointments in outpatient endocrinology and orthopedic clinics.
Results:
We identified 295 patients who were eligible for the FLS pathway; from this group, 57 declined an endocrinology follow-up visit. Of the remaining 238 patients, 95 (40 %) had appointments but subsequently canceled and 7 (3 %) did not show up for their appointments. No follow-up information was documented for 77 patients (32 %). Thus, only 59 of 238 (25 %) kept their appointments in endocrinology. In the univariate analyses, age, severity of illness, and discharge status were associated with follow-up adherence only in the orthopedic cohort (P ≤ 0.02). However, the adjusted analyses did not identify any variables that were associated with follow-up adherence in either the endocrinology or orthopedic cohorts.
Conclusion:
Post fracture outpatient follow-up was lower for the endocrinology cohort, as compared with the orthopedic cohort, even among patients enrolled in an FLS. Factors that were previously postulated to influence follow-up, including those described in this study, showed no association with appointment-keeping behavior. Possibly, the importance of osteoporosis treatment is not emphasized or the treatment options are unappealing to our patient population. Further study is needed to determine the specific obstacles contributing to the low endocrine post fracture follow-up rate.
Key Message:
Fracture liaison services can reliably reduce future fracture events, but follow-up adherence after hospitalization remains challenging. We compared the rates of endocrinology vs orthopedic follow-up in a single cohort of patients hospitalized for fragility fractures and assessed variables that potentially contributed to the lower endocrinology follow-up rate (eg, travel distance, age, marital status). However, no factors were identified as having a significant effect. These data show that the specific obstacles previously thought to contribute to lower-than-expected post fracture follow-up rates are misleading, and novel approaches are needed to address this widespread issue.
