A territorially coordinated, eHealth-supported fracture liaison service following femur fragility fracture: a pilot randomised controlled trial.

Abstract

A territorially coordinated, eHealth-supported Fracture Liaison Service (FLS) was implemented to standardize secondary fracture prevention across an Integrated Health Area. Following a pilot usability study, a 1-year randomized trial compared the eHealth-supported FLS with usual care in adults aged ≥ years with surgically treated femur fragility fractures. Primary outcomes included refractures and hospital readmissions, while secondary outcomes assessed functional recovery, longitudinal osteoporosis treatment prescription, treatment adherence, mortality, and professional usability of the digital platform.

Purpose: Fracture Liaison Services (FLS) improve secondary fracture prevention, but implementation remains heterogeneous and digital integration is limited. We evaluated the feasibility and clinical impact of a territorially coordinated, eHealth-supported FLS standardising post-fracture care across an Integrated Health Area.

Methods: This multicentre pilot project comprised two phases: an initial study evaluating a web-based platform's technical performance and usability, followed by a prospective, open-label effectiveness study randomising 119 adults aged ≥65 years with surgically treated femur fragility fractures to an eHealth-supported FLS pathway (n = 60) or usual care (n = 59). Primary outcomes were refractures and hospital readmissions; secondary outcomes included functional recovery, treatment prescription, mortality and platform usability.

Results: Baseline characteristics were comparable, although the FLS group had a more favourable pre-fracture functional profile. Functional recovery was higher in the FLS group throughout follow-up, with significantly higher Barthel Index scores at 3, 6 and 12 months (80.1 vs. 61.2 at 12 months; P ≤ 0.01). Readmissions were similar and refractures infrequent, without significant differences. Osteoporosis treatment prescription was more sustained in the FLS group. All eight deaths occurred in the FLS group and none in control; given the small sample, this should not be read as a causal effect.

Conclusions: A territorially coordinated, eHealth-supported FLS was feasible and was associated with better functional recovery and more sustained osteoporosis treatment prescription than usual care in the first year after femur fragility fracture. No significant differences were observed in refractures or readmissions; findings support further evaluation of digitally coordinated territorial FLS models in larger studies.

Trial registration: ClinicalTrials.gov NCT05266755, registered prospectively on 23 February 2022.