Digitally enhanced fracture liaison service in Austria—a feasibility analysis

Abstract Summary Fragility fractures often signal untreated osteoporosis. This study shows that a digitally enhanced Fracture Liaison Service (FLS) can identify affected patients in routine hospital care and improve structured assessment and treatment. Dedicated staff remain essential to translate digital solutions into effective fracture prevention. Purpose Although Fracture Liaison Services (FLS) are established internationally, structured programs remain scarce in Austria. This study aimed to assess the real-world feasibility of a digitally supported, International Osteoporosis Foundation (IOF)–certified FLS implemented in routine inpatient care. Methods We conducted a retrospective, monocentric cohort study at a tertiary care hospital in Vienna, Austria. Hospitalized patients aged ≥ 50 years with major osteoporotic fractures were included in a digital FLS module integrated into the hospital information system between April 2023 and March 2024. Feasibility parameters included patient capture rate, implementation of standardized diagnostics, and initiation or recommendation of osteoporosis therapy. Results Overall, 141 patients were enrolled (78% women; mean age 75.8 ± 11.4 years). Vertebral (31.9%) and hip fractures (25.5%) were the most frequent fracture sites. A previous fragility fracture was documented in 46.1% of patients; 24.1% had a prior diagnosis of osteoporosis. In total, 38.1% of all eligible inpatients with osteoporotic fractures were included in the digital FLS. Calcium and vitamin D supplementation was initiated during hospitalization in 73.0% of patients. Specific antiosteoporotic medication was initiated during the inpatient stay in 15.6% and in the outpatient setting in 9.9% and 8.5% of patients, respectively. Treatment was recommended for post-discharge initiation in 56.0% of cases. The most commonly prescribed drugs were denosumab and zoledronic acid. Conclusion Implementation of a digitally integrated FLS in routine inpatient care is feasible and enables structured identification, assessment, and treatment recommendation for patients with fragility fractures. However, limited staffing resources and challenges in post-discharge therapy implementation highlight the need for dedicated personnel and improved cross-sectoral care pathways.