An Optimised Fracture Liaison Service Model: Maintained Diagnostic Sensitivity Despite Reduced Number of Diagnostic Tests Performed.

Patients suffering a low-energy fracture are at high risk of subsequent fractures. Investigation of all fragility fracture patients above the age of 50 years is recommended in order to prevent further fractures. The aim of this study was to investigate alternative strategies including known risk factors (age, sex, and body weight) for selecting fracture patients for osteoporosis assessment and investigate how these strategies would affect the proportion of patients with osteoporosis identified and the number of patients referred for Dual X-ray Absorptiometry (DXA) compared with the original FLS strategy. From OFELIA; a cohort study comprising 794 fragility fracture patients we included 622 patients aged 18 + years (mean age 56 ± 17) with fragility fractures. We investigated the predictive value of clinical risk factors using ROC curves and AUC analyses. The revised strategies were compared by analyzing sensitivity and specificity of different strategies based on sex, age, BMI, and bodyweight. For patients 50 + years, a strategy investigating men and women with body weight ≤ 85 kg resulted in sensitivity and specificity of 94% and 25%, respectively, reducing the number of DXAs by 21%. For patients < 50 years, the prevalence of osteoporosis was low and it was, therefore, difficult to develop an acceptable strategy. We found that the original FLS strategy can be modified to include substantially fewer patients and still only miss the osteoporosis diagnosis in a very few patients. A modified strategy would potentially save costs and concerns in many patients.

OFELIA: Prevalence of Osteoporosis in Fragility Fracture Patients.

Worldwide, a care gap has been recognized between presenting with a fracture and prevention of the next fracture. Fracture Liaison Service is the most cost-effective method to close this gap, but its implementation is sparse in the Nordic countries. To assess the need for a fracture prevention program, the primary aim of this study was to estimate the prevalence of osteoporosis in patients treated for fragility fractures at Aarhus University Hospital, Denmark. Secondary aims were to identify clinical risk factors associated with osteoporosis and the up-take of anti-osteoporosis treatment. The study was conducted as a cross-sectional study and patients aged 18+ years were consecutively identified over a 12 months period. Of 1164 identified patients, 832 were included and 794 (70% women, 66% aged ≥ 50 years) patients completed the study. Bone mineral density was measured by DXA and information about clinical risk factors were obtained. The overall prevalence of osteoporosis in this cohort was 14.9%, increasing to 20.3% in patients ≥ 50 years (22.9% in women, 9.6% in men). In addition to age above 50 years, female sex, low BMI, and early menopause were significantly associated with osteoporosis. At 3-years follow-up in patients diagnosed with osteoporosis, 95% of patients who initiated anti-osteoporosis treatment after their fracture were still adherent to treatment. Given that osteoporosis was demonstrated in one in five fragility fracture patients above 50 years, OFELIA stresses the need for implementation of a program aiming at securing appropriate investigation and treatment of osteoporosis in patients presenting a fragility fracture.