What question did this study set out to answer?

This study aims to assess whether a risk-stratified approach in fracture liaison services improves treatment initiation and fracture outcomes.

June 14, 2026Open Access

Risk stratification improves outcomes in an osteoporosis fracture liaison service

SKShejil KumarThe University of Sydney LNLillias NairnMcMaster University ABAngela BowmanRoyal North Shore Hospital

Key Points

This study aims to assess whether a risk-stratified approach in fracture liaison services improves treatment initiation and fracture outcomes.
Cohort study comparing two patient groups at Royal North Shore Hospital from 2015 to 2023.
Group FLS1 followed traditional selection criteria, while FLS2 used a risk-stratified approach based on age and fracture type.
Data analyzed included clinical characteristics, fracture risk estimation, and treatment initiation rates.
FLS2 patients had higher 10-year fracture risk (36.0% vs 27.4%, p < 0.001) and more initiated pharmacotherapy (79.0% vs 64.6%, p < 0.001).
Risk-stratified approach estimated 72 osteoporotic fractures averted vs 44 with traditional method (p < 0.001).
More hip fractures averted in FLS2 (20 vs 10 per 1000 patients, p < 0.001).

Abstract

Selecting patients at higher baseline risk of fragility fracture may optimise clinical outcomes and cost-effectiveness of hospital fracture liaison services (FLS). In this cohort study, we found a risk-stratified approach led to a higher rate of treatment initiation and estimated number of fractures prevented compared to the traditional FLS strategy. PURPOSE: Hospital-based fracture liaison services (FLS) are cost-effective and reduce refracture risk. However, optimal FLS characteristics to maximise clinical and cost-effectiveness are uncertain. METHODS: We reviewed data for FLS patients at Royal North Shore Hospital, Sydney (2015-2023). In 2018, the patient selection strategy was adjusted from a traditional approach (any fragility fracture, ≥ 50 years) to preferentially invite those either ≥ 60 years with any fragility fracture, or any presenting with hip and/or vertebral fractures. Cohorts entering the service pre-(FLS1) and post-this timepoint (FLS2) were compared regarding clinical characteristics, estimated fracture risk and pharmacotherapy initiation. Modelling was performed to estimate fractures averted. RESULTS: The total cohort (n = 1903) was median 68-years-old and predominantly female (77%). Both cohorts were similar in sex distribution and prevalence of various fracture risk factors. The FLS2 cohort was older (median 69 vs 65 years, p < 0.001), more frequently presented with hip/vertebral fracture (21.4% vs 13.8%, p < 0.001), had higher Garvan-estimated 10-year fracture-risk (median 36.0% vs 27.4%, p < 0.001) and more frequently initiated pharmacotherapy (79.0% vs 64.6%, p < 0.001). In the overall cohort, strongest predictors of treatment initiation were older age, osteoporotic bone density, hip/vertebral fracture and female sex. Over 5 years, risk-stratified FLS was estimated to avert more osteoporotic (72 vs 44, p < 0.001) and hip fractures (20 vs 10, p < 0.001) per 1000 patients compared with traditional FLS. CONCLUSION: In this large hospital-based FLS study, a risk-stratified selection strategy was associated with more frequent pharmacotherapy initiation and estimated to avert more fractures; however, longitudinal assessment of treatment adherence and refracture rates is required to confirm utility.

Ask AI

Helpful

Bookmark

View Full Paper