Abstract
Background Osteoporosis is a major public health issue, progressing with the aging of the population and responsible for nearly 400,000 fractures/year in France. Fracture Liaison Services (FLS) are systems of detection and secondary prevention of osteoporotic fractures. These systems are recognized as effective by international scientific societies. Objectives The aim of this study was to evaluate the efficiency of Reims Hospital FLS protocol after 25 months of implementation. Methods We performed an ambispective monocentric observational study at the Reims Hospital between April 2016 and May 2018. We included patients over 50 years who were hospitalized in the orthopedic department for osteoporotic fractures. These patients were evaluated clinically, biologically and radiographically during a one-day hospitalization in the rheumatology unit. Therapeutic compliance and fracture recurrence were assessed in consultation at 3-month and 1-year telephone interviews. Results Sixty-four/242 patients (26.4%) identified in orthopedic service were included. The average age was 72 years old with a sex ratio of 1:10. The most common fracture was the proximal end of the femur for 25 patients (39%). Fifty-five patients (85.9%) had an indication for osteoporosis treatment, the most prescribed was zoledronic acid for 45 patients (81.9%). Twenty-four/55 patients (43.6%) started their treatment and 22/24 (91.7%) were still treated at one year. One patient (1.63%) died within the follow-up period. Twelve/55 patients (21.8%) presented a new fall and 7/55 patients (12.7%) experienced a new fracture. Comparative analysis of observant versus non-observant population groups at 1 year showed that non-observant patients had significantly more recurrent falls (93.54% versus 68.18%, p = 0.024) and received treatment of zoledronic acid (93.56% versus 63.64%, p = 0.010). Further analysis showed that our low rate of initiation treatment was due to difficulties in implementing bisphosphonates, mainly because of the dental care needed. However, we observed a high rate of treatment adhesion at 1 year, once the treatment is started. During this study, we identified 2 areas of improvement: therapeutic education to improve patient adherence and fall risk factors to decrease recurrent fall rate. Conclusion There is a real benefit to the establishment of this FLS with a high rate of therapeutic compliance at 1 year follow-up. However there are opportunities for improvements in treatment initiation through patients therapeutic education.
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