Background: Fracture impose significant morbidity, mortality and economic burden (1). Studies confirm low rates of identification and secondary prevention for patients discharged from Emergency Department (ED) with a fracture.
Objectives: To evaluate the performance of a simplified FLS which identified patients using an Emergency Department Database (EDIS) in a Tertiary Australian hospital as part of a State Health Research Advisory Service research translation project.
Methods: Patients aged >50 yrs who presented to the Emergency Department after a fracture at the tertiary hospital were invited to the SCGHFLS. Control goups: SCGH (SCGHR) (historical fracture risk without an active FLS) and a comparator tertiary hospital (FH) ( prospective control.
Data collection: baseline, 3 & 12 months. Data collected: awareness of osteoporosis, investigations, medication use, health care utilization, falls & fracture information and quality of life (EQ-5D).
Results: 167 (69.3%) of eligible patients agreed to attend the Fragile Bone Clinic. The SCGHFLS reduced the recurrence of minimal trauma fractures over 12 months (8.9% vs 21.3% vs 20.3%, pawareness of osteoporosis compared to FH and by 35.6% compared to the SCGHR over 12 months (p<0.001). The SCGHFLS had higher prescription rates of calcium (57.4% vs 28.8%), vitamin D (59.8% vs 33.0%), calcium plus vitamin D (48.4% vs 19.8%) and anti-resorptive therapy (29.9% vs 16.2%) compared to SCGHR. At 12 months the SCGHFLS had the highest rate (46.9%) of patients initiated on pharmacological treatment compared to FH(41.5%) and SCGHR(16.0%). The FLS incrementally improved the prescription, adherence and compliance with of osteoporosis treatment.
By 12 months the Fracture Liaison Service reduced recurrent fracture rate from 210 to 89/1000py ie absolute risk reduction 12%, falls reduction and improved rates of pharmacological treatment & patient awareness of osteoporosis. Benefits were seen as early as 3 months.