Poster Presentation Annual Meetings of the Endocrine Society of Australia and Society for Reproductive Biology and Australia and New Zealand Bone and Mineral Society 2016

Fracture liaison service (FLS) implemented in a metropolitan tertiary centre improved treatment and recurrent fracture rates by 12 months (#312)

Charles Inderjeeth 1 , Warren Raymond 1 , David Mountain 2 , Elizabeth Geelhoed 3 , Andrew Briggs 4 , David Oldham 2 , Jean McQuade 5
  1. North Metropolitan Health and University of Western Australia, Nedlands, WA, Australia
  2. Sir Charles Gairdner Hospital, Perth, WA, Australia
  3. Population Health, University of Western Australia, Perth, WA, Australia
  4. School of Physiotherapy, Curtin University, Perth, WA, Australia
  5. Arthritis and Osteoporosis WA, Perth, WA, Australia

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.

  1. Briggs, AM, et al., Hospitalisations, admission costs and re-fracture risk related to osteoporosis in Western Australia are substantial: a 10-year review. Australian and New Zealand Journal of Public Health, 2015. 39(6): p. 557-562.