Adherence to secondary fracture prevention is associated with reduced risk of subsequent fractures

Attenders to fracture liaison services in a quality assessment study of 1936 women and men ≥ 50 years had 20% lower risk of subsequent fractures and 33% lower mortality than non-attenders. Patient's who were adherent to AOD after 12 months had a 49% lower risk of fractures than non-adherent patients.

Secondary fracture prevention rates are low in Norway and internationally. To overcome the existing treatment gap, fracture liaison services (FLS) are recommended. The study aimed to assess impact of FLS on fracture rates and mortality among attenders versus non-attenders, and patients adherent versus non-adherent to AOD.

This single-center sub-study of the Norwegian Capture the Fracture Initiative included 1936 women and men ≥ 50 years of age with an index fracture of any type during 2015-2018. We estimated hazard ratios (HR) for subsequent fractures and mortality in 1041 attenders versus 895 non-attenders to the FLS, and 427 patients who were adherent versus 174 patients who were non-adherent to anti-osteoporotic drugs (AOD) 12 months after treatment initiation.

During a median 3.5-years observation (range 0.5 to 6.3), attenders had a 20% lower risk of subsequent fractures of any type (HR 0.80; 95% CI 0.64-0.999) and 33% lower mortality (HR 0.67; 95% CI 0.51-0.89) than non-attenders. Patients who were adherent to AOD after 12 months had a 49% lower risk of subsequent fractures than non-adherent patients (HR 0.51; 95% CI 0.35-0.72), but no difference in mortality was shown. Models were adjusted for age, sex, body mass index, smoking, prior fracture, and index hip fracture.

These results confirm that patients who were able and willing to attend FLS had lower risk of subsequent fractures and mortality than non-attenders. Patients who were adherent to AOD had lower risk of subsequent fractures than non-adherent patients, emphasizing the importance of adherence in secondary fracture prevention.