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Health Outcomes in Fragility Fractures in the Spanish Registry of Osteoporotic Fractures According to the FLS Care
Leonor Cuadra-LLopart1, Samantha Santana Zorrilla2, Daniel Martínez-Laguna3
1Geriatric Department, Hospital Universitari de Terrassa, Terrassa, Spain; Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain.
Background:
Fracture Liaison Services (FLS) are the gold standard for secondary fracture prevention, but their characteristics vary depending on the care model. This study describes the differences between Orthogeriatric (FLS-ORT) and Bone Metabolism (FLS-MET) models in Spain, based on data from the national osteoporotic fracture registry.
Methods:
We conducted a retrospective, multicenter cohort study including 8,962 patients aged ≥50 years with fragility fractures from 25 active FLS in Spain (2019-2023). Patients were classified based on the care model: FLS-ORT (n = 3,695) or FLS-MET (n = 5,267). Baseline characteristics, fracture types, treatment initiation, adherence, and 12-month outcomes were compared.
Results:
FLS-ORT patients were older (85 vs. 78 years, p <0.001), had more comorbidities, and a higher risk of falls. Hip fractures were predominant in FLS-ORT (75.8%), while vertebral fractures were more frequent in FLS-MET (p <0.001). Time from fracture to FLS assessment was shorter in FLS-ORT (0.1 vs. 1.6 months, p <0.001). At 12 months, fracture recurrence was higher in FLS-ORT (7.7 vs. 5.5 per 100 patient-years), and mortality was significantly greater (p <0.0001). However, osteoporosis treatment initiation (84.6%) and adherence (85.2%) were comparable across models.
Conclusions:
FLS are the gold standard for secondary fracture prevention. Both FLS care models (FLS-ORT and FLS-MET) were effective in reducing the risk of new fractures in patients and minimizing the impact on the quality of life of patients who suffer a fragility fracture. Future integration into a unified model assessing all fractures is anticipated.
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