Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative)
Camilla Andreasen, Cecilie Dahl, Frede Frihagen, Tove T. Borgen, Trude Basso, Jan‐Erik Gjertsen, Wender Figved, Torbjørn Wisløff, Gunhild Hagen, Ellen M. Apalset, Jens M. Stutzer, Ida Katrine Lund, Å. Hansen, Frida Igland Nissen, Ragnar M. Joakimsen, Unni Syversen, Erik Fink Eriksen, Lars Nordsletten, Tone Kristin Omsland, Åshild Bjørnerem, Lene Bergendal Solberg
Abstract
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.