April 03, 2018
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Fracture liaison service increases BMD testing, osteoporosis treatment

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Adults with osteoporosis who received care from a fracture liaison service program were more likely to undergo bone mineral density testing and initiate and adhere to osteoporosis treatment vs. adults receiving usual care, according to study findings published in Bone.

Fracture liaison services are defined as coordinator-based models of secondary fracture prevention services, designed to identify patients at increased risk for secondary fractures and to ensure the patients initiate appropriate treatment via improved care coordination and communication, Chih-Hsing Wu, MD, associate professor in the department of family medicine at National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan, and colleagues wrote in the study background. In 2013, the International Osteoporosis Foundation initiated the promotion of fracture liaison service programs worldwide, but the literature suggests varied outcomes, the researchers noted.

In a meta-analysis and systematic literature review, Wu and colleagues analyzed data from 16 randomized controlled trials and 58 observational studies conducted in adults with osteoporosis aged at least 50 years between January 2000 and February 2017. Studies assessed patients with osteoporosis-related fractures in a hospital, clinic, community or home-based setting, managed using either a fracture liaison service program or usual care. Researchers assessed measurement of BMD at any site, treatment initiation, adherence to treatment, incidence of refracture and rates of all-cause mortality.

In the 37 studies that reported on BMD testing, researchers found that unweighted average rates of BMD testing were 48% in the fracture liaison service arms and 23.5% in the usual care arms, with follow-up periods ranging from 3 to 26 months. In meta-analysis, patients who participated in fracture liaison service interventions were more likely to undergo BMD testing vs. controls (absolute risk increase, 0.24; 95% CI, 0.18-0.29), with results persisting in separate analyses of randomized controlled trials and observational studies.

In 46 studies reporting on osteoporosis treatment initiation rates, fracture liaison service interventions were associated with a 20% higher absolute risk increase in treatment initiation rates vs. control arms (95% CI, 0.16-0.25). In 25 studies assessing adherence to osteoporosis treatment, researchers found that fracture liaison service interventions were associated with a 22% higher absolute risk increase in adherence to medication (95% CI, 0.13-0.31), with follow-up ranges of 3 to 48 months across studies.

In 11 studies evaluating rates of refracture, fracture liaison service interventions were associated with a 5% reduction in absolute risk for refracture vs. usual care (95% CI, –0.08 to –0.03; number needed to treat = 20), with follow-up ranges of 6 to 72 months.

Mortality among patients in a fracture liaison service intervention was reduced by 3% compared with usual care (95% CI –0.05 to –0.01).

“[Fracture liaison services] are clinically effective across a range of important outcomes in patients with fractures of osteoporosis, indicating that they play a significant role in minimizing the burden of disease,” the researchers wrote. – by Regina Schaffer

Disclosures: Amgen supported this study. One of the study authors reports he received consulting fees from Amgen, and another author reports he served as an advisor to Complete HEOR Solutions, LLC.