Efficacy of a Computerized Therapeutic Decision-Making Algorithm in a Fracture Liaison Service Targeting Hip Fracture...

Introduction: This study evaluates the efficacy of a nurse practitioner-managed, computer algorithm-supported institutional fracture liaison service (FLS) that provides treatment recommendations for patients with hip fractures. Methods: A retrospective study included patients hospitalized in the Orthopedic ward with hip fractures between April 1 and October 31. The decision-making algorithm recommends zoledronic acid as the default medication, except for patients younger than 65 years, with estimated glomerular filtration rate (eGFR) <35 or prior osteoporosis therapy, who are ordered to undergo endocrinology consultation. Patients with vitamin D deficiency/insufficiency are given a loading dose. Results: Two hundred and eight hip fracture patients were identified. The cohort was predominantly female (137/208, 65.9%); the mean age was 79.9 ± 9.6 years. Nurse practitioner evaluation was performed in 200/208 patients (96.2%). The algorithm provided a treatment recommendation in 140 out of 200 (70.0%), while 60 out of 200 (30.0%) required an endocrinology consultation. A Vitamin D loading dose was given in 89/99 (89.9%) deficiency and 44/62 (71.0%) insufficiency cases. Conclusions: This simplified algorithm-based FLS model demonstrated practicality and feasibility in providing therapeutic recommendations with minimal physician intervention.