Abstract
Previous studies evaluating fracture liaison service (FLS) programs have found them to be cost-effective, efficient, and reduce the risk of fracture. However, few studies have evaluated the clinical effectiveness of these programs. We compared the patient populations of those referred for osteoporosis management by FLS to those referred by primary care physicians (PCP), within the Canadian healthcare system in the province of Ontario. Specifically, we investigated if a referral from FLS is similarly effective as PCP at identifying patients at risk for future osteoporotic fractures and if osteoporosis therapies have been previously initiated. A retrospective chart review of patients assessed by a single Ontario rheumatology practice affiliated with FLS between January 1, 2014, and December 31, 2017, was performed identifying two groups: those referred by FLS within Hamilton and those referred by their PCP for osteoporosis management. Fracture risk of each patient was determined using FRAX. A total of 573 patients (n = 225 (FLS group) and n = 227 (PCP group)) were evaluated. Between the FLS and PCP groups, there were no significant differences in the absolute 10-year risk of a major osteoporotic fracture (15.6% (SD = 10.2) vs 15.3% (SD = 10.3)) and 10-year risk of hip fracture (4.7% (SD = 8.3) vs 4.7% (SD = 6.8)), respectively. 10.7% of patients referred by FLS and 40.5% of patients referred by their PCP were on osteoporosis medication prior to fracture. Our study suggests that referral from FLS is similarly effective as PCP at identifying patients at risk for future osteoporotic fractures, and clinically effective at identifying the care gap with the previous use of targeted osteoporosis therapies from referral from PCP being low and much lower in those referred by FLS. Interventional programs such as FLS can help close the treatment gap by providing appropriate care to patients that were not previously identified to be at risk for fracture by their primary care physician and initiate proper medical management.
Highlights
Osteoporosis, a skeletal disorder, is characterized by compromised bone strength predisposing individuals to an increased risk of fracture
For the patients referred by the primary care physician (PCP) for osteoporosis management, given that the number of non-fracture liaison service (FLS) referred patients exceeded the number of patients referred through FLS, a random sample of the PCP-referred patients was obtained. ese patients were not required to have sustained a fracture to satisfy the referral criteria, which reflects the current standard of care. ese patients were randomly selected using a computerized program from a list of all patients referred for osteoporosis assessment by their PCP between 2011–2017 and were matched 1 : 1 to the number of referred patients through FLS
Baseline demographics are provided in Table 1. ere were no significant differences in the gender, age, body mass index, menopausal status, smoking history, and alcohol use between patients referred by FLS and patients referred by their PCP
Summary
Osteoporosis, a skeletal disorder, is characterized by compromised bone strength predisposing individuals to an increased risk of fracture. E most common of these osteoporotic fractures include breaks in the vertebrae of the spine, bones of the forearm/wrist, and the hip, with such fractures being a source of substantial morbidity for individuals suffering from osteoporosis [2]. Illustrating the growing economic burden of osteoporosis within Canada, the economic cost of osteoporosis is estimated to have grown from $1.3 billion dollars in 1993 to $4.6 billion dollars by 2016 [4]. Despite this growing economic cost and significant morbidity of osteoporosis, less than 20% of patients with fragility fractures are examined or treated with antiresorptive
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