Association between recurrent fracture risk and implementation of fracture liaison services in four Swedish hospitals : A cohort study
Journal article
Axelsson, Kristian F., Johansson, Helena, Lundh, Dan, Möller, Michael and Lorentzon, Mattias. (2020). Association between recurrent fracture risk and implementation of fracture liaison services in four Swedish hospitals : A cohort study. The Lancet Diabetes & Endocrinology. 35(7), pp. 1216-1223. https://doi.org/10.1002/jbmr.3990
Authors | Axelsson, Kristian F., Johansson, Helena, Lundh, Dan, Möller, Michael and Lorentzon, Mattias |
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Abstract | Structured secondary preventions programs, called fracture liaison services (FLSs), increase the rate of evaluation with bone densitometry and use of osteoporosis medication after fracture. However, the evidence regarding the effect on the risk of recurrent fracture is insufficient. The aim of this study was to investigate if implementation of FLS was associated with reduced risk of recurrent fractures. In this retrospective cohort study, electronic health records during 2012 to 2017 were used to identify a total of 21,083 patients from four hospitals in Western Sweden, two with FLS (n = 15,449) and two without (n = 5634). All patients aged 50 years or older (mean age 73.9 [SD 12.4] years, 76% women) with a major osteoporotic index fracture (hip, clinical spine, humerus, radius, and pelvis) were included. The primary outcome was recurrent major osteoporotic fracture. All patients with an index fracture during the FLS period (n = 13,946) were compared with all patients in the period before FLS implementation (n = 7137) in an intention‐to‐treat analysis. Time periods corresponding to the FLS hospitals were used for the non‐FLS hospitals. In the hospitals with FLSs, there were 1247 recurrent fractures during a median follow‐up time of 2.2 years (range 0–6 years). In an unadjusted Cox model, the risk of recurrent fracture was 18% lower in the FLS period compared with the control period (hazard ratio = 0.82, 95% confidence interval [CI] 0.73–0.92, p = .001), corresponding to a 3‐year number needed to screen of 61, and did not change after adjustment for clinical risk factors. In the hospitals without FLSs, no change in recurrent fracture rate was observed. Treatment decisions were made according to the Swedish treatment guidelines. In conclusion, implementation of FLS was associated with a reduced risk of recurrent fracture, indicating that FLSs should be included routinely at hospitals treating fracture patients. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research. |
Keywords | fracture; fracture liaison service; osteoporosis; recurrent fracture |
Year | 2020 |
Journal | The Lancet Diabetes & Endocrinology |
Journal citation | 35 (7), pp. 1216-1223 |
Publisher | The Lancet Publishing Group |
ISSN | 2213-8587 |
Digital Object Identifier (DOI) | https://doi.org/10.1002/jbmr.3990 |
Scopus EID | 2-s2.0-85082142028 |
Open access | Published as ‘gold’ (paid) open access |
Page range | 1216-1223 |
Funder | Swedish Research Council |
Sahlgrenska Universitetssjukhuset | |
Vetenskapsrådet | |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | 23 Mar 2020 |
Publication process dates | |
Accepted | 29 Jan 2020 |
Grant ID | ALFGBG-716051 |
2017-02229 |
https://acuresearchbank.acu.edu.au/item/896w7/association-between-recurrent-fracture-risk-and-implementation-of-fracture-liaison-services-in-four-swedish-hospitals-a-cohort-study
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Publisher's version
OA_Axelsson_2020_Association_Between_Recurrent_Fracture_Risk_and.pdf | |
License: CC BY-NC 4.0 | |
File access level: Open |
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