Risk stratification improves outcomes in an osteoporosis fracture liaison service

Area of Science:

• Gerontology
• Orthopedics
• Public Health

Background:

• Hospital-based fracture liaison services (FLS) are established for reducing refracture risk and are cost-effective.
• Optimal strategies for FLS patient selection to maximize clinical and economic benefits remain under investigation.

Purpose of the Study:

• To evaluate the impact of a risk-stratified patient selection strategy on treatment initiation and fracture prevention within a hospital FLS.
• To compare the outcomes of a traditional FLS approach with a revised strategy prioritizing higher-risk patients.

Main Methods:

• A retrospective cohort study analyzed data from 1903 patients at Royal North Shore Hospital (2015-2023).
• The FLS selection criteria were updated in 2018, shifting from a broad approach to one focusing on older age (≥60) and/or hip/vertebral fractures.
• Clinical characteristics, estimated fracture risk, and pharmacotherapy initiation were compared between pre- and post-update cohorts. Fracture prevention was modeled.

Main Results:

• The revised strategy (FLS2) included older patients with higher baseline fracture risk and more hip/vertebral fractures.
• Pharmacotherapy initiation increased significantly in the FLS2 cohort (79.0% vs 64.6%).
• The risk-stratified FLS was estimated to avert more osteoporotic and hip fractures per 1000 patients over 5 years compared to the traditional FLS.

Conclusions:

• A risk-stratified patient selection approach for hospital FLS is associated with increased pharmacotherapy initiation.
• This strategy is estimated to prevent a greater number of osteoporotic and hip fractures.
• Further research is needed to assess long-term treatment adherence and refracture rates.