Clinical Outcomes of a Coordinator-Based Fracture Liaison Service for Hip Fractures in Korea

Hip fractures in older adults are associated with high rates of mortality, functional decline, and secondary fractures. Although Fracture Liaison Services (FLSs) have shown clinical benefits in many countries, a comprehensive, coordinator-based FLS model has not been widely implemented in Korea. This study aimed to evaluate the clinical impact of a newly introduced coordinator-based FLS in elderly hip fracture patients.

This prospective cohort study included patients aged 65 and older who were admitted with a hip fracture to a single tertiary hospital between June 2022 and February 2024. Patients were divided into two groups: those who received FLS after July 2023 (n = 105) and those who did not (n = 168). Clinical data were collected during hospitalization and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Variables included time to surgery, length of hospital stay, mortality, refracture rate, osteoporosis treatment rates, functional and nutritional outcomes, and patient satisfaction.

The FLS group had significantly shorter time to surgery (2.5 ± 2.3 vs. 4.4 ± 5.5 days, P < 0.001) and hospital stay (20.0 ± 11.3 vs. 24.7 ± 18.0 days, P = 0.010). In-hospital mortality (1.0% vs. 4.2%), 6-month (4.8% vs. 6.5%), and 1-year mortality (8.6% vs. 12.5%) were all lower in the FLS group (P < 0.05). Refracture rates at 6 months (2.8% vs. 7.1%) and 1 year (5.7% vs. 10.7%) were also significantly lower in the FLS group (P < 0.05). Osteoporosis medication prescription (68.6% vs. 48.8%) and calcium/vitamin D supplementation (63.8% vs. 15.9%) were significantly higher in the FLS group (P < 0.001). Although no significant differences were observed in functional recovery, the FLS group showed a significant increase in serum albumin over 1 year (P = 0.022). Patient satisfaction exceeded 90% at all follow-up intervals.

The coordinator-based FLS service reduced the length of hospital stay and time from admission to surgery in elderly hip fracture patients, while also lowering the risk of postoperative mortality and refracture. It increased the prescription rate of osteoporosis medications and can improve patients' nutritional status. However, further research is needed to assess functional improvement.