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Fracture Prevention in the Orthopaedic Environment: Outcomes of a Coordinator-Based Fracture Liaison Service

Bogoch, Earl R. MD1,2,a; Elliot-Gibson, Victoria MSc2,b; Beaton, Dorcas PhD2,3,c; Sale, Joanna PhD2,3,d; Josse, Robert G. MB, BS4,e

doi: 10.2106/JBJS.16.01042
Scientific Articles

Background: Fracture liaison services focus on secondary fracture prevention by identifying patients at risk for future fracture and initiating appropriate evaluation, risk assessment, education, and therapeutic intervention. This study describes key clinical outcomes including bone mineral densitometry, physician assessment, and pharmacotherapy initiation in pharmacotherapy-naïve patients undergoing treatment for fragility fracture in a Canadian fracture liaison service.

Methods: We determined rates of post-fracture investigation and treatment for inpatients and outpatients with a fragility fracture seen in a coordinator-based fracture liaison service at an urban university trauma hospital. The program identified distal radial, proximal femoral, proximal humeral, and vertebral fragility fractures in female patients ≥40 years of age and male patients ≥50 years of age and provided education, bone mineral densitometry, inpatient consultation or outpatient specialist or primary care physician referral for bone health management, and documented patient follow-up.

Results: The 2,191 patients with a fragility fracture were not taking anti-osteoporosis pharmacotherapy at the time of identification (862 inpatients and 1,329 outpatients). Eighty-four percent of inpatients and 85% of outpatients completed a bone mineral densitometry as recommended. Fifty-two percent of patients with proximal femoral fracture, 29% of patients with vertebral fracture, 26% of patients with proximal humeral fracture, and 20% of patients with distal radial fracture had osteoporosis confirmed on the basis of a bone mineral densitometry T-score of ≤−2.5 at the femoral neck or L1 to L4. Eighty-five percent of inpatients and 79% of outpatients referred for bone health management were assessed by a specialist or primary care physician. Of the patients who attended their appointments, 73% of inpatients and 52% of outpatients received a prescription for anti-osteoporosis medication.

Conclusions: A high rate of education, evaluation, and pharmacological treatment, if indicated, can be achieved through a coordinator-facilitated fracture liaison service program.

Clinical Relevance: Fracture prevention programs are currently engaged in establishing and modifying fracture liaison services in a quest for practical and effective models. The program described in this article exemplifies a coordinator-based model that produced good outcomes.

1Division of Orthopaedic Surgery, University of Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada

2Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada

3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

4Department of Medicine, University of Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada

aE-mail address for E.R. Bogoch:

bE-mail address for V. Elliot-Gibson:

cE-mail address for D. Beaton:

dE-mail address for J. Sale:

eE-mail address for R.G. Josse:

Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated
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