Profile of Vertebral Fracture Cases in the First Full Year of an ANP led Fracture Liaison Service

Abstract

Abstract Background A specialist osteoporosis and bone health service was founded in 2003 in our institution. It see’s a range of patients from providing DXA alone to giving specialist opinion on complex cases. The Irish Fracture Liaison Service Database (FLS-DB) commenced in 2020 and aims to target those who’ve just fractured with the aim of reducing risk of further imminent fracture by screening for osteoporosis and initiating bone protection measures. Methods Cases of vertebral fracture screened by our FLS ANP were extracted from the FLS database. Case finding for vertebral fracture remains dependent on referral to the service. Results We screened 53 patients with vertebral fractures through our FLS in 2023. 64% female, 36% male. Median age 81 years; range 56-99 yrs. Of these 32 (60%) were inpatients with 2 inpatient falls. 17 (32%) were on osteoporosis treatment. We noted 25 (47%) with previous fragility fracture including 9 (17%) with previous vertebral fracture – just over half of these i.e. 5 patients were on bone protection treatment. After FLS assessment of those on treatment 10 were changed to denosumab, 2 to teriparatide, one continued oral bisphosphonate by choice, rest changed to IV zoledronic acid. Those newly started on treatment a range of PO and IV Bisphosphonate, teriparatide and denosumab was recommended depending on patient factors. One declined. All were prescribed vitamin D +/- calcium supplements. Conclusion The UK FLS-DB estimated that the number of ‘clinical’ vertebral fractures roughly equates to that of hip fractures, so this denominator has been used for the Irish FLS-DB. This would correlate with our service assessing 29% of expected clinical vertebral fractures in 2023. Appointment of a dedicated ANP for fracture liaison has streamlined bone health assessment for acute fractures attending our hospital. Further work on case finding needed to ensure we are assessing all patients at increased risk of further fracture.