Abstract
Osteoporosis and fractures are a significant burden on the NHS. Fracture liaison services (FLS) may help alleviate this burden through accelerated comprehensive, multidisciplinary care. This study aimed to assess compare the healthcare resource use and relevant clinical outcomes of patients treated at hospitals with an FLS with those without an FLS. The investigators utilized Hospital Episode Statistics, an administrative healthcare dataset covering all secondary care interactions in England. Patients with newly diagnosed fragility fractures and osteoporosis were identified with the relevant ICD-10 from April 2012 to March 2018 in the dataset. An audit performed by the National Osteoporosis Society was utilized to classify trusts into gold (fully configured FLS), grey (partially configured FLS), and black (no FLS) in 2016. Healthcare resource use and clinical outcomes were assessed. Comparisons were made between patients in treated among the 3 cohorts, where matching based on age, sex, fracture site, socioeconomic deprivation and Charlson Co-Morbidity Index was performed. There were 51,212, 72,149, and 106,689 patients included from gold, grey and black trusts, respectively. Refracture rates, rates of pneumonia, deep vein thrombosis, and inpatient mortality do not appear to have significantly decreased between gold and black, and grey and black trusts, with p > 0.05. However, trusts with an FLS have a significant reduction in non-elective admissions (p< 0.0001), mean length of stay (p<0.0001), and outpatient appointments (p<0.0001). There were significant inpatient and outpatient cost savings of £176.08 per patient (p< 0.0001) among those treated in trusts with an FLS compared to those without. This trend held for both 1 year and 2 years from fracture. FLS do not appear to reduce morbidity post-fracture, but result in significant cost savings to the healthcare system. Deeper investigation into the impact of FLS should be performed, along with an examination of proper implementation of such services.
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