骨折联络服务（FLS）与降低后续脆性骨折风险及死亡率相关：挪威骨折防治计划（NoFRACT）
Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative).
作者信息
Andreasen Camilla, Dahl Cecilie, Frihagen Frede, Borgen Tove T, Basso Trude, Gjertsen Jan-Erik, Figved Wender, Wisløff Torbjørn, Hagen Gunhild, Apalset Ellen M, Stutzer Jens M, Lund Ida, Hansen Ann K, Nissen Frida I, Joakimsen Ragnar M, Syversen Unni, Eriksen Erik F, Nordsletten Lars, Omsland Tone K, Bjørnerem Åshild, Solberg Lene Bergendal
机构信息
Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway.
Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
出版信息
Osteoporos Int. 2025 Mar;36(3):501-512. doi: 10.1007/s00198-024-07376-y. Epub 2025 Jan 14.
UNLABELLED
Subsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures.
PURPOSE
Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality.
METHODS
The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011-2015) or intervention period (2015-2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated.
RESULTS
A total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83-0.92) and 10% in men (HR 0.90, 95% CI 0.81-0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79-0.86) and 15% in men (HR 0.85, 95% CI 0.81-0.89).
CONCLUSION
A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.
未标注
比较了骨折联络服务（FLS）引入前后的后续骨折发生率及相关死亡率。在100198名女性和男性中，FLS使后续脆性骨折风险降低了13%和10%，死亡率降低了18%和15%。该研究表明FLS可能预防骨折。
目的
需要有效的骨折预防策略来控制全球骨折负担。我们调查了标准化骨折联络服务（FLS）干预对后续骨折风险和死亡率的影响。
方法
NoFRACT研究设计为一项多中心、务实、注册支持的阶梯式楔形整群随机试验。FLS干预于2015年5月至2018年12月期间分三个整群以4个月的间隔引入，包括对50岁以上低能量骨折患者的骨质疏松症评估和治疗。根据挪威患者注册中心的数据，根据骨折时间将索引骨折患者分配到对照期（2011 - 2015年）或干预期（2015 - 2018年）。计算后续脆性骨折（远端前臂、近端肱骨或髋部）发生率和全因死亡率。
结果
共有100198名患者（平均年龄69.6岁）发生了任何类型的索引骨折。在最长4.7年的随访期间，11%（6948名）女性和6%（2014名）男性发生了后续脆性骨折，20%（14324名）女性和22%（8326名）男性死亡。FLS使女性后续脆性骨折风险降低13%（风险比（HR）0.87，95%置信区间（CI）0.83 - 0.92），男性降低10%（HR 0.90，95%CI 0.81 - 0.99），女性死亡率降低18%（HR 0.82，95%CI 0.79 - 0.86），男性降低15%（HR 0.85，95%CI 0.81 - 0.89）。
结论
标准化的FLS干预与较低的后续脆性骨折风险和死亡率相关，可能有助于减轻全球骨折负担。
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