Fracture Liaison Service at a University Hospital with Level 1 Trauma Center 1 year later

Abstract

Introduction The Fracture Liaison Service (FLS) model improves osteoporosis care following fragility fractures in adults (1) . Our institution has implemented the FLS model housed within our Department of Orthopedics utilizing the American Orthopedic Association Own the Bone (OTB) program. Objectives To address the gap in osteoporosis care following fragility fracture a Type A FLS (2) was implemented in October 2016. The study purpose was to compare secondary fracture prevention before and after institution of the FLS program. We complete all steps from identifying patients, investigating for secondary osteoporosis, ordering bone mineral density (BMD) studies and prescribing medication. Methods The Study population was 305 adults >50 referred to FLS from 10/2016-9/2017. The FLS Physician Assistant(PA) completed a consult consisting of a detailed history, education regarding nutrition: calcium, vitamin D and protein and discussing weight bearing exercise and balance training with Physical Therapy and falls prevention and lifestyle changes: smoking cessation and limiting use of alcohol. BMD and lab work were ordered by the FLS PA. Outpatient follow up with the FLS PA was recommended to review the results and initiate osteoporosis medication. The reference control group, identified by chart review, was 1024 adults>50 with primary care in our system from 2008-2014 who sustained a hip, wrist or vertebral fracture. CPT codes were used to assess if patient had a BMD and 25(OH)D level after the fracture. Results In the reference group 14.5% of patients had a BMD study and 22.6% of patients had 25(OH)D level completed after the fracture. 305 adults with mean age 74 and 76% female were included in the study group. Hip fractures occurred in 50% and 27% had vertebral fractures. 63% had sustained a prior fracture over the age of 50. The FLS obtained a BMD in 47.5% of patients, 50% of patients had a 25(OH)D level checked and 34% of patients started medication treatment after the fracture(determined by phone call or in person follow up). Nearly half of the subjects were lost to follow up despite a phone call and letters to patient and primary care physician. 37% of the study group completed in person outpatient follow up with the FLS PA at our institution. Of that subset of patients, 90% had a BMD study, 97% had a 25(OH)D level checked and 65% are on medication treatment for osteoporosis. Comparing the two groups showed improvement in use of BMD and 25(OH) D assessment after fracture. Conclusion Implementing a Type A FLS model of care within our institution has led to improved osteoporosis care for patients >50 who sustained a fragility fracture.