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The Clinical Impact of Fracture Liaison Services: A Systematic Review

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dc.contributor.authorBarton, David W.en
dc.contributor.authorPiple, Amit S.en
dc.contributor.authorSmith, C. Tayloren
dc.contributor.authorMoskal, Sterling A.en
dc.contributor.authorCarmouche, Jonathan J.en
dc.contributor.departmentVirginia Tech Carilion School of Medicineen
dc.date.accessioned2021-06-04T11:46:12Zen
dc.date.available2021-06-04T11:46:12Zen
dc.date.issued2021-01-09en
dc.description.abstractIntroduction: A fracture liaison service (FLS) is a coordinated system of care that streamlines osteoporosis management in the orthopaedic setting and can serve as an effective form of secondary preventative care in these patients. The present work reviews the available evidence regarding the impact of fracture liaison services on clinical outcomes. Methods: The literature was reviewed for studies reporting changes in the rates of bone mineral density scanning (DXA), antiresorptive therapy, new minimum trauma fractures, and mortality between cohorts with access to an FLS or not. Studies including intention to treat level data were retained. A Medline search for "fracture liaison" OR "secondary fracture prevention" produced 146 results, 98 were excluded based on the abstract, 38 were excluded based on full-text review. Ten level III studies encompassing 48,045 patients were included, of which 5 studies encompassing 7,086 were analyzed. Odds-ratios for DXA and anti-osteoporosis pharmacotherapy rates were calculated from data. Fixed and random effects analyses were performed using the Mantel-Haenszel method. Results: Four studies reported, on average, a 6-fold improvement in DXA scanning rates (Figure 1). Six studies reported, on average, a 3-fold improvement in antiresorptive therapy rates (Figure 2). Four large studies reported significant reductions in the rate of new fractures using time-dependent Cox proportional hazards models at 12 months (HR = 0.84, 0.95), 24 months (HR = 0.44, 0.65), and 36 months (HR = 0.67). Five large studies reported mortality improvements using time-dependent Cox proportional hazards models at 12 months (HR = 0.88, 0.84, 0.81) and 24 months (HR = 0.65, 0.67). Conclusions: The findings suggest that fracture liaison services improve rates of DXA scanning and antiresorptive therapy as well as reductions in the rates of new fractures and mortality among patients seen following minimum trauma fractures across many time points.en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1177/2151459320979978en
dc.identifier.eissn2151-4593en
dc.identifier.issn2151-4585en
dc.identifier.other2151459320979978en
dc.identifier.pmid33489430en
dc.identifier.urihttp://hdl.handle.net/10919/103608en
dc.identifier.volume12en
dc.language.isoenen
dc.rightsCreative Commons Attribution-NonCommercial 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/en
dc.subjectfracture liaison serviceen
dc.subjectFLSen
dc.subjectminimum trauma fractureen
dc.subjectminimum trauma fractureen
dc.subjectosteoporosisen
dc.subjectDXAen
dc.subjectfracture preventionen
dc.subjectbisphosphonateen
dc.subjectmortalityen
dc.subjectsystematic reviewen
dc.subjectquality improvementen
dc.titleThe Clinical Impact of Fracture Liaison Services: A Systematic Reviewen
dc.title.serialGeriatric Orthopaedic Surgery & Rehabilitationen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.dcmitypeStillImageen

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