Real-life effectiveness of a Fracture Liaison Service in reducing short-term mortality and second fractures after hip fracture: a five-year prospective study

Abstract

Summary

We evaluated the long-term impact of a Fracture Liaison Service (FLS) in elderly hip fracture patients. FLS implementation improved one-year survival and significantly reduced the risk of secondary fractures in adherent patients. However, no significant differences in five-year mortality were observed. Structured care improves short-term outcomes and treatment adherence.

Purpose

Hip fractures are the most serious type of fragility fractures, as they are associated with increased short- and long-term all-cause mortality. The implementation of Fracture Liaison Service (FLS) programs has improved the management of osteoporosis-related fractures and demonstrated clinical effectiveness. This study aimed to evaluate the impact of an FLS model on survival rates, mortality reduction, and secondary fracture prevention over a five-year period.

Methods

We conducted a prospective cohort study on patients aged 60 years and older who sustained a hip fracture before and after FLS implementation at our centre (January 2016–December 2019). Patients were followed for five years. Mortality, complications, and secondary fractures were analysed using a multivariate Cox proportional hazards model.

Results

A total of 1,401 patients were included (355 pre-FLS and 1,046 post-FLS). The prescription of anti-osteoporotic drugs significantly increased after FLS implementation (77.5% vs. 12.1%; p < 0.01), as did adherence to treatment (48.9% vs. 30.2%; p = 0.02). One-year mortality was lower in the post-FLS group [18.3% vs. 22.0%; adjusted HR 0.77 (0.60–0.99); p = 0.045]. However, five-year mortality rates showed no significant differences between groups (59.1% vs. 54.6%; p = 0.14). Patients adherent to osteoporosis treatment had a significantly lower risk of secondary fractures (10.8% vs. 19.1%; p < 0.01).

Conclusion

Implementing an FLS protocol was associated with a significant reduction in one-year mortality and improved adherence to osteoporosis treatment, leading to a lower risk of secondary fractures. However, no significant difference was observed in overall five-year mortality.