Barton David W, Piple Amit S, Smith C Taylor, Moskal Sterling A, Carmouche Jonathan J
Department of Orthopaedic Surgery, University of Florida College of Medicine, Jacksonville, Florida, FL, USA.
Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Geriatr Orthop Surg Rehabil. 2021 Jan 11;12:2151459320979978. doi: 10.1177/2151459320979978. eCollection 2021.
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.
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.
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).
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.
骨折联络服务（FLS）是一种协调的护理系统，可简化骨科环境中的骨质疏松症管理，并可作为这些患者二级预防护理的有效形式。本研究回顾了有关骨折联络服务对临床结局影响的现有证据。
回顾文献，以研究报告有或无骨折联络服务的队列之间骨密度扫描（DXA）率、抗吸收治疗、新的最小创伤性骨折和死亡率的变化。保留包括意向性治疗水平数据的研究。在Medline上搜索“骨折联络”或“继发性骨折预防”，得到146个结果，基于摘要排除98个，基于全文回顾排除38个。纳入了10项三级研究，共48,045名患者，其中分析了5项研究，共7,086名患者。根据数据计算DXA和抗骨质疏松药物治疗率的优势比。使用Mantel-Haenszel方法进行固定效应和随机效应分析。
四项研究报告，DXA扫描率平均提高了6倍（图1）。六项研究报告，抗吸收治疗率平均提高了3倍（图2）。四项大型研究报告，使用时间依赖性Cox比例风险模型，在12个月（HR = 0.84, 0.95）、24个月（HR = 0.44, 0.65）和36个月（HR = 0.67）时，新骨折率显著降低。五项大型研究报告，使用时间依赖性Cox比例风险模型，在12个月（HR = 0.88, 0.84, 0.81）和24个月（HR = 0.65, 0.67）时，死亡率有所改善。
研究结果表明，骨折联络服务可提高DXA扫描率和抗吸收治疗率，并降低多个时间点最小创伤性骨折后患者的新骨折率和死亡率。
