Refracture following fracture liaison service assessment illustrates the requirement for integrated falls and fracture services.

The Fracture Liaison Service (FLS) allows appropriate antiosteoporosis therapy to be targeted to potentially reduce future fracture risk. A proportion of these treated patients will still experience a further fracture. This work reviews the characteristics of these patients. Data were collated for patients >65 years old presenting to the South Glasgow FLS between January 2001 and August 2004. There were 2,489 patients who presented (incident fracture group), and 129 (5.2%) sustained an additional fracture (refracture group). Median age of the incident fracture group was 77.8 years vs. 80.6 years for the refracture group (P = nonsignificant). The refracture group was determined according to whether their incident fracture was hip (n = 47) or nonhip (n = 82). When the incident fracture was hip, a refracture was more likely to be a further hip fracture (chi(2) = 14.4, P = 0.002) and patients refractured sooner (median time to refracture 194 [range 10-1,134] days vs. 258 [range 6-1,081] days [nonhip]) (P = nonsignificant). In the refracture group, 76% of patients were already on osteoporosis treatment after their incident fracture. Patients over 65 years of age presenting to FLS who sustain an additional fracture are older; are likely to sustain another hip fracture after an incident hip fracture; often refracture early, particularly when the incident fracture is of the hip; and are often already on antiosteoporosis treatment. Therefore, it is important to identify these high-risk patients and offer a combined approach of prompt drug treatment through a systematic and specialist osteoporosis management team along with reducing any reversible falls risk factors.

The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture.

INTRODUCTION: Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow. METHODS: An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. RESULTS: During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service's osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine. CONCLUSIONS: The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.