Yoel Uri, Alkobi Weiss Hadar, Goldbart Adi, Silverman Siris Ethel, Fisher David Louis, Hassan Lior, Fraenkel Merav
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Endocrinology Unit, Soroka University Medical Center, Beer Sheva, Israel.
Osteoporos Int. 2025 Feb;36(2):299-309. doi: 10.1007/s00198-024-07325-9. Epub 2024 Dec 18.
The implementation of an in-hospital fracture liaison service facilitated prompt initiation of anti-osteoporosis treatment following a hip fracture (HF), increasing follow-up and treatment rates. This led to a 48% reduction in the risk of subsequent HF and a 29% decrease in mortality rates.
To demonstrate the impact of an institutional fracture liaison service (FLS) which allowed in-hospital anti-osteoporosis treatment following hip fracture (HF) on subsequent HF and mortality rate.
We retrospectively evaluated patients aged 65 years and older, admitted with an osteoporotic HF, who were transferred following surgery for rehabilitation in the geriatrics department in two time periods: before and after the implementation of an institutional FLS ("geriatric-pre-FLS" and "geriatric-FLS" cohorts, respectively). Data were captured from electronic records and the two cohorts were compared following an assessment of baseline characteristics, follow-up, and anti-osteoporosis treatment initiation. A multivariable Cox regression model evaluated differences between the cohorts regarding subsequent HF and mortality rates.
Three hundred and eighteen and 448 patients comprised the geriatric-pre-FLS (07/2008-06/2014) and the geriatric-FLS (03/2016-03/2020) cohorts, respectively. Baseline characteristics were comparable between the cohorts (median age 81 vs. 82, p = 0.08 and female sex 73% vs. 70%, p = 0.48, respectively). Rates of endocrine consultation (3.5% vs. 99%%, p < 0.001), DXA-BMD testing (7.5% vs. 34%, p < 0.001), and parenteral anti-osteoporosis treatment (4% vs. 76.6%, p < 0.001) were all higher in the geriatric-FLS cohort. The implementation of the FLS led to a 48% reduction in subsequent HF risk (HR 0.52; 95% CI 0.37-0.74, p < 0.001) and a 29% decrease in mortality rate (HR 0.71; 95% CI 0.54-0.92, p = 0.011).
The implementation of an in-hospital FLS facilitated prompt initiation of anti-osteoporosis treatment following a HF, increased follow-up and treatment rates, and resulted in a 48% reduction in subsequent HF risk and a 29% reduction in mortality rates.
医院内骨折联络服务的实施促进了髋部骨折（HF）后抗骨质疏松治疗的及时启动，提高了随访率和治疗率。这使得后续髋部骨折风险降低了48%，死亡率降低了29%。
证明机构骨折联络服务（FLS）允许髋部骨折（HF）后在医院内进行抗骨质疏松治疗对后续髋部骨折和死亡率的影响。
我们回顾性评估了65岁及以上因骨质疏松性髋部骨折入院、术后转至老年医学科进行康复治疗的患者，分为两个时间段：机构FLS实施前和实施后（分别为“老年医学科FLS实施前”和“老年医学科FLS实施后”队列）。数据从电子记录中获取，在评估基线特征、随访情况和抗骨质疏松治疗启动情况后对两个队列进行比较。多变量Cox回归模型评估了队列之间在后续髋部骨折和死亡率方面的差异。
“老年医学科FLS实施前”队列（2008年7月至2014年6月）有318例患者，“老年医学科FLS实施后”队列（2016年3月至2020年3月）有448例患者。队列之间的基线特征具有可比性（中位年龄分别为81岁和82岁，p = 0.08；女性比例分别为73%和70%，p = 0.48）。老年医学科FLS实施后队列的内分泌科会诊率（3.5%对99%，p < 0.001）、双能X线吸收法骨密度检测率（7.5%对34%，p < 0.001）和肠外抗骨质疏松治疗率（4%对76.6%，p < 0.001）均更高。FLS的实施使后续髋部骨折风险降低了48%（风险比0.52；95%置信区间0.37 - 0.74，p < 0.001），死亡率降低了29%（风险比0.71；95%置信区间0.54 - 0.92，p = 0.011）。
医院内FLS的实施促进了髋部骨折后抗骨质疏松治疗的及时启动，提高了随访率和治疗率，并使后续髋部骨折风险降低了48%，死亡率降低了29%。
