Low Trauma Research Articles

Enhanced initiation of osteoporosis management in hip fracture surgery patients

Introduction: Hip fracture unit (HFU) is seeing ~350 elderly patients (>60 years old) a year with low trauma fracture. Osteoporosis management is one of the key performance indicators of managing those patients. The evidence showed that patients started on osteoporosis treatment within 3 months post hip fracture surgery had 35% less chance for another hip fracture and 28% reduction in mortality. As collaboration between osteoporosis clinic and Geriatric falls clinic was limited, several logistic steps took time and hassled patients resulting in delayed treatment and losing follow up. In 2013-14, only 81 (29.5%) out of 275 hip surgery patients were started on osteoporosis treatment. Practice change implemented: Hence, the HFU team members decided to implement the initiation process of osteoporosis treatment in post-operative patients while waiting for discharge or transfer to rehabilitation units. Workflow is as follows; Osteoporosis case manager (OPCM) follows HFU Geriatrician’s round. Geriatrician indicates the patients who benefit from osteoporosis treatment. Decision of treatment depends on patient’s mobility status, renal function, type of fracture and operation, and risk of future hip and major osteoporosis fracture (FRAX score). Bone mineral density will be done on second post-operative day (POD). OPCM counsels and educates to the patient and family. Dental referral is made on POD 3 if patient chooses Denosumab or Zoledronate. Patient will be treated with appropriate dental procedure, if needed, follow up appointment will be given. All information are written in patient’s transfer summary before being discharged to step down rehabilitation units or falls clinic. OPCM will follow up on treatment initiation. Aim and Theory of Change: This project was to early initiate process of osteoporosis treatment to maximize the number of appropriate patients receiving treatment without significant delay. Targeted population and stakeholders: The project was targeted to elderly osteoporotic hip fracture, who underwent hip fracture surgery. Geriatrician, orthopaedic surgeon, dental surgeon, osteoporosis case manager, doctors from rehabilitation unit, and falls clinic nurses are main stake holders in this project. Timeline: Timeline started in January 2015 and it is ongoing till December 2016. Highlights: It is the innovative improvement program implemented for hip fracture patients in local healthcare system. Many patients were identified and outcomes have been improved along the way. In 2015, out of 266 hip fracture surgical patients, 106 (39.8%) patients were seen by osteoporosis case manager. Thirty seven (34.9%) were confirmed for osteoporosis treatment in an assigned timing. In 2016 till September, 141(57.1%) out of 247 hip fracture surgical patients were educated resulting 1.43 times more coverage and 110 (78%) were confirmed for treatment resulting 2.23 times increased number of patients to start treatment. Major impact went towards patients who timely received appropriate osteoporosis medication. It proved the result of a team work involving different departments and institutions. It also revealed increased healthcare resource utilization in an organization. Sustainability: Sustainability was ascertained by continuous outcome improvement, use of non-costly resources, and common data collection system. Transferability: The project is meant to spread to other geriatric wards for patients who are suitable for osteoporosis treatment.

Urology Consultation Is Not Necessary in Patients with Low Grade Renal Trauma

Urology Consultation Is Not Necessary in Patients with Low Grade Renal Trauma

Mid-term follow-up and coping strategies of bone cement leakage after percutaneous kyphoplasty

To retrospectively analyze the clinical data of 17 patients with bone cement leakage after percutaneous kyphoplasty and explore the leakage type and mid-term clinical effects. The clinical data of 17 patients with osteoporotic vertebral compression fractures occurred bone cement leakage after percutaneous kyphoplasty from October 2011 to October 2016 were collected. There were 7 males and 10 females, aged from 68 to 87 years old with an average of 78 years. All the patients had the history of low emergy trauma who had normal activity and full self-care for living before trauma, and complained with the lower back pain without signs and symptoms of nerve root injury after trauma. According to the anatomical location by images, the bone cement leakage pathways was confirmed, the preoperative and postoperative vertebral body height and Cobb angle were measured, the improvement of spinal stenosis were recorded. Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index(ODI) were used to evaluate pain and daily activities. All the patients were followed up for 4 to 7 years with an average of 5.1 years. According to anatomical location by images, we found the bone cement leakage pathways of vertebral side type in 6 cases, intervertebral disc type in 3 cases, spinal canal type in 2 cases, vertebral pedicle type in 5 cases and mixed type in 1 case. Vertebral body height from preoperative(27.7±3.5)% restored to (56.4±2.5)% at final follow-up, and the kyphosis was corrected with Cobb angle from preoperative(45.3±4.2)° corrected to(18.3±3.1)° at final follow-up. VAS score decreased from preoperative 7.9±1.5 to 2.1±0.5 at final follow-up. ODI obviously restored from preoperative(49.1±7.5)% to (23.5±3.7)% at final follow-up. The nerve symptoms in lower limbs occurred in 2 cases, and the neurological symptom was disappeared after urgent symptomatic treatment and anaphase trophic nerve treating. Lower back pain occurred in 3 cases, including one case of unbearable pain, and the pain disappeared after symptomatic treatment. Although the rate of bone cement leakage during percutaneous vertebral kyphoplasty is not low, the bone cement leakage has little influence on PKP surgery. Even if a little leakage occurred within the spinal canal during the surgery, spinal canal decompression will not be needed urgently. The significant clinical symptoms caused by leakage can basically disappear after treatment in mid-term follow-up.

023Bone Health Checklist with Pharmacy Support Improves the Management of Low Trauma Fractures: A Quality Improvement Project

023Bone Health Checklist with Pharmacy Support Improves the Management of Low Trauma Fractures: A Quality Improvement Project

The CANVAS trial programme raises more questions than answers

The CANVAS trial programme raises more questions than answers

Does regional loss of bone density explain low trauma distal forearm fractures in men (the Mr F study)?

Men with distal forearm fractures have reduced bone density at the lumbar spine and hip sites, an increased risk of osteoporosis and a higher incidence of further fractures. The aim of this case-control study was to investigate whether or not there is a regional loss of bone mineral density (BMD) at the forearm between men with and without distal forearm fractures. Sixty-one men with low trauma distal forearm fracture and 59 age-matched bone healthy control subjects were recruited. All subjects underwent a DXA scan of forearm, hip and spine, biochemical investigations, health questionnaires, SF-36v2 and Fracture Risk Assessment Tool (FRAX). The non-fractured arm was investigated in subjects with fracture and both forearms in control subjects. BMD was significantly lower at the ultradistal forearm in men with fracture compared to control subjects, in both the dominant (mean (SD) 0.386g/cm2 (0.049) versus 0.436g/cm2 (0.054), p<0.001) and non-dominant arm (mean (SD) 0.387g/cm2 (0.060) versus 0.432g/cm2 (0.061), p=0.001). Fracture subjects also had a significantly lower BMD at hip and spine sites compared with control subjects. Logistic regression analysis showed that the best predictor of forearm fracture was ultradistal forearm BMD (OR=0.871 (0.805-0.943), p=0.001), with the likelihood of fracture decreasing by 12.9% for every 0.01g/cm2 increase in ultradistal forearm BMD. Men with low trauma distal forearm fracture have significantly lower regional BMD at the ultradistal forearm, which contributes to an increased forearm fracture risk. They also have generalised reduction in BMD, so that low trauma forearm fractures in men should be considered as indicator fractures for osteoporosis.

A study on clinical and radiological outcome following surgically managed intertrochanteric fractures using PFN-A

Background: Intertrochanteric fractures is the fracture of the proximal femur, in which the fracture line extends from the greater trochanter to lesser trochanter 1. Intertrochanteric fractures are common in patients above 60 years of age, however it may also occur in young adults. Nine out of ten intertrochanteric fractures occur in elderly, which is usually of a low velocity trauma occurring with the female to male ratio of 3:1.We studied the clinical outcome of unstable intertrochanteric fracture surgically managed by PFN-A. Materials & Methods: Design: A preliminary study. Duration: August 2015 - December 2016 Sample: 30 patients with unstable intertrochanteric fractures were treated surgically by PFN-A. Inclusion criteriaAge –All patients after skeletal maturity. Cases of intertrochanteric fractures based on AO system of classification Exclusion criteriaPatients with sub-trochanteric fractures. Non-ambulatory patients before injury. Patient unfit for anaesthesia. Patients with Osteoarthritis of hip before injury They were followed up for a minimum period of 1 year by the senior author and evaluated for clinical outcome using X-RAYS, SALVATTI and WILSON HIP SCORE.Results: Out of 30 cases 28 cases had excellent results without complications. 1 case had helical blade backed out, and did not come for follow up other case had superior migration of the helical blade, but the fracture is united.Conclusion: In our study of 30 cases of unstable intertrochanteric fractures, were effectively treated surgically with PFN-A gave excellent results & to be considered the best surgical modality for unstable Intertrochanteric fracture management.

Bone Mineralization and Fracture Risk Assessment in the Pediatric Population

Identifying children most susceptible to clinically significant fragility fractures (low trauma fractures or vertebral compression fractures) or recurrent fractures is an important issue facing general pediatricians and subspecialists alike. Over the last decade, several imaging technologies, including dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, have become useful to identify abnormal bone mineralization in children and in adolescents. This review aimed to summarize the latest literature on the utility of these modalities as they pertain to use in pediatrics. In addition, we review several disease states associated with poor bone health and increased fracture risk in children, and discuss the implications of low bone mineral density in these patients. Finally, we will highlight the gaps in knowledge with regard to pediatric bone health and make recommendations for future areas of research.

Recurrent Metatarsal Fractures in Postmenopausal Woman With Low Serum Alkaline Phosphatase: A Rare Diagnosis Not to Miss.

Hypophosphatasia (HPP) is a rare inborn error of metabolism due to a loss-of-function mutation in the gene for tissue nonspecific isoenzyme of alkaline phosphatase (ALP) that results in low levels of ALP. The clinical presentation of HPP is variable and in adults can easily be misdiagnosed as other forms of osteomalacia. We present a case of a 53-year-old Caucasian female who was evaluated for recurrent metatarsal fractures. She reported her first metatarsal fracture at age 21, and since then had at least 8 more metatarsal fractures over her lifetime, most without injury other than weight bearing. She reported history of gait disturbance as a child and dental issues (spacing and loosening). Laboratory tests showed normal serum calcium, phosphorus, and parathyroid hormone, but low serum ALP <20 IU/L and elevated N-telopeptide. Foot X-ray showed several healed and nonhealed metatarsal fractures, and bone densitometry revealed osteopenia. She was treated with calcium and vitamin D. A year later she had a new metatarsal fracture and a nontraumatic pelvic fracture. Teriparatide therapy was attempted but not tolerated. Due to suspicion of HPP vitamin B6 levels were checked and found to be elevated at 263 µg/L. Given her clinical presentation and low ALP levels with elevated vitamin B6, the diagnosis of HPP was made. Clinicians should be attentive to a history of recurrent low trauma fractures, premature loss of deciduous teeth, and persistently low serum ALP to suspect this diagnosis. Early case detection with the availability of recent Food and Drug Administration–approved asfotase alfa may avoid years of undiagnosed morbidity.

Treatment of proximal humerus fracture using proximal humerus locking plating

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Proximal humerus fractures are the most common upper extremity fractures in older patients. The aim of the present study was to evaluate the functional outcome and complications of proximal humeral locking plate used for healing proximal humerus fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective study was conducted at the department of Orthopaedics, Sir T. Hospital, Bhavnagar, from June 2008 to March 2010, with 20 patients who suffered with complex proximal humerus fractures and underwent surgical treatment with proximal humerus locking plates. Functional outcome was assessed at the final follow up by using Constant Murley score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age of the patients was 52 years. Male: female ratio was 1.5: 2. The most common mode if injury is low velocity trauma i.e. fall while walking or fall in bathroom seen in 13 patients. Average time for clinical union was 60 days, while average time for radiological union is 90 days taken in the study. Postoperative complications were seen in 2 patients. Delayed complications were seen in 10 cases. No patients had shown implant related complications. At the final follow up according to Constant Murley score, 36% patients had shown excellent results, 53% patients had shown good results and poor results were seen in 11% of cases.&lt;/p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our results show that good to excellent outcome can be achieved in treating proximal humerus fractures using locking plates in elderly patients. Early mobilization of the shoulder can be achieved without compromising fracture union.

Osteoporosis in Children with Chronic Illnesses: Diagnosis, Monitoring, and Treatment.

Osteoporosis is an under-recognized complication of chronic illness in childhood. This review will summarize recent literature addressing the risk factors, evaluation, and treatment for early bone fragility. Criteria for the diagnosis of pediatric osteoporosis include the presence of low trauma vertebral fractures alone or the combination of low bone mineral density and several long bone fractures. Monitoring for bone health may include screening for vertebral fractures that are common but often asymptomatic. Pharmacologic agents should be offered to those with fragility fractures especially when spontaneous recovery is unlikely. Controversies persist about the optimal bisphosphonate agent, dose, and duration. Newer osteoporosis drugs have not yet been adequately tested in pediatrics, though clinical trials are underway. The prevalence of osteoporosis is increased in children with chronic illness. To reduce the frequency of fragility fractures requires increased attention to risk factors, early intervention, and additional research to optimize therapy and potentially prevent their occurrence.

Trends in post osteoporotic hip fracture care from 2010 to 2014 in a private hospital in Malaysia

ObjectiveFollowing an osteoporotic fracture, pharmacological treatment is recommended to increase bone mineral density and prevent future fractures. However, the rate of starting treatment after an osteoporotic hip fracture remains low. The objective of this study was to survey the treatment rate following a low-trauma hip fracture at a tertiary private hospital in Malaysia over a period of 5 years. MethodsThe computerised hospital discharge records were searched using the terms “hip,” “femur,” “femoral,” “trochanteric,” “fracture,” or “total hip replacement” for all patients over the age of 50, admitted between 2010 and 2014. The medical charts were obtained and manually searched for demographic data and treatment information. Hip operations done for non–low-trauma-related fracture and arthritis were excluded. ResultsThree hundred seventy patients over the age of 50 years were admitted with a hip fracture, of which 258 (69.7%) were low trauma, presumed osteoporotic, hip fractures. The median age was 79.0 years (interquartile range [IQR], 12.0). Following a hip fracture, 36.8% (95 of 258) of the patients received treatment, but out of these, 24.2% (23 of 95) were on calcium/vitamin D only. The median duration of treatment was 1 month (IQR, 2.5). In 2010, 56.7% of the patients received treatment, significantly more than subsequent years 2011–2014, where approximately only 30% received treatment. ConclusionsFollowing a low-trauma hip fracture, approximately 72% of patients were not started on active antiosteoporosis therapy. Of those who were, the median duration of treatment was 1 month. This represents a missed opportunity for the prevention of future fractures.

Long-term use of bisphosphonates in osteoporosis.

Objectives:To report and describe the management and response to treatment of patients referred to the osteoporosis clinic after prolonged use of bisphosphonate BPs) (4 years and more) with and without new fracture (any site) or any other new skeletal symptoms.Methods:This is a single center observational retrospective cohort study conducted from January 2009 to May 2016 in a tertiary center. We describe cause of referral, X-rays findings, management, and response to treatment.Results:Thirty-four patients, aged 46-89 years, were collected. Reason for referral included review of therapy (11 patients), recent low trauma fracture (21 patients), or chronic severe thigh pain (2 patients) of unknown etiology. All patients with fracture or thigh pain (23/34 patients) were treated with teriparatide 20 mcg daily. Sixteen of them (16/23) completed teriparatide course (18-24 months), 11 patients had complete healing of fracture at the end of the course, and 5 remained with nonunion of fracture, the remaining 5 patients were lost to follow up.Conclusion:Prolonged use of bisphosphonates can lead to atypical femoral fracture that may involve sites other than femoral shaft or rarely chronic thigh pain without fracture. Teriparatide may facilitates fracture healing and improve thigh pain.

Telomere length in alcohol dependence: A role for impulsive choice and childhood maltreatment

Telomere shortening, a marker of cellular aging, has been considered to be linked with psychosocial stress as well as with chronic alcohol consumption, possibly mediated by oxidative stress and inflammatory response. Recent findings suggested that early life adversity on telomere dynamics may be related to impulsive choice. To further our understanding of the association of impulsive choice and childhood trauma on telomere length, we examined whether delayed discounting and childhood trauma or their interaction is related to leukocyte telomere length, while controlling for multiple potential confounding variables, in patients with alcohol dependence who are considered to have higher impulsive choice and shorter telomere length. We recruited 253 male patients with chronic alcohol dependence. All participants performed the delay discounting task, and the area under curve was used as a measure of delay discounting. Steeper delay discounting represents more impulsive choices. The modified Parent-Child Conflict Tactics Scale was used to measure childhood maltreatment. In addition, confounding factors, including socio-demographic characteristics, the Alcohol Use Disorders Identification Test, the Buss-Perry Aggression Questionnaire, the Resilience Quotient, the Beck Depression Inventory, and the Beck Anxiety Inventory, were also assessed. Hierarchical regression analyses showed a significant main effect of delay discounting (β=0.161, t=2.640, p=0.009), and an interaction effect between delay discounting and childhood maltreatment on leukocyte telomere length (β=0.173, t=2.138, p=0.034). In subsequent analyses stratified by childhood maltreatment, patients with alcohol dependence and high childhood trauma showed a significant relationship between delay discounting and leukocyte telomere length (β=0.279, t=3.183, p=0.002), while those with low trauma showed no association between them. Our findings suggest that higher impulsive choice is associated with shorter telomere length, and childhood trauma may exert a moderating effect in the relationship between impulsive choice and telomere length.

Differential Influence of Social Support in Emerging Adulthood Across Sources of Support and Profiles of Interpersonal and Non-Interpersonal Potentially Traumatic Experiences

ABSTRACTSocial support is protective against the negative effects of trauma, yet how these effects vary across sources of support and patterns of trauma exposure has not been examined. High co-occurrence exists among different types of trauma across domains and ages, yielding patterns of trauma exposure that may affect social support. This study identified profiles of potentially traumatic events (PTEs) experienced by 252 college students and examined the relationships between social support and mental health across these profiles. Five profiles emerged: “Non-Interpersonal Trauma Exposure,” “Adult Intimate Partner Violence,” “Poly-trauma Exposure,” “Low Trauma Exposure,” and “Childhood Family Violence.” The link between social support and adjustment differed across profiles. Family support was valuable for promoting resilience across patterns of PTEs. Friend and romantic partner support were related to lower mental health problems. Support from family and friends is particularly valuable in the context of adult intimate partner violence and childhood family violence.

Fracture Burden: What Two and a Half Decades of Dubbo Osteoporosis Epidemiology Study Data Reveal About Clinical Outcomes of Osteoporosis.

This review aims to highlight important clinical findings from the over 25year-long Dubbo Osteoporosis Epidemiology Study particularly focusing on outcomes post fracture. Every low trauma fracture in the elderly is associated with an increased risk of a subsequent fracture, with a higher risk in men than women. All major or proximal fractures and even minor fractures in the very elderly or minor fractures that are then followed by re-fracture are associated with premature mortality, greatest in the first 5years post fracture. Having a subsequent fracture further increases this high mortality risk, but if an individual survives the high risk period, their risk returns to that of the background population. Non-hip non-vertebral fractures account for a significant proportion of the premature mortality. Despite an improvement in overall health and population mortality over the years, excess mortality post fracture has not changed in the last 2 decades. All low trauma, fractures in the elderly herald a high risk of poor outcomes, particularly in the first few years post fracture. Early intervention should be initiated.

Prevalence and Risk Factors of Osteoporosis in Postmenopausal Women with Type 2 Diabetes Mellitus.

Patients with type 2 diabetes (T2DM) are at increased risk of fractures. The aim of this study is to analyze the prevalence and risk factors of osteoporosis and osteoporosis related fractures in postmenopausal women with T2DM. A total of 112 postmenopausal women with T2DM and 171 control nondiabetic women received a standardized questionnaire on osteoporosis risk factors, and were evaluated for bone mineral density (BMD, by using a dual energy X-ray absorptiometry), biochemical markers of bone and glucose metabolism, soluble receptor for advanced glycation end products (sRAGE) and its gene polymorphisms (rs1800625 or rs2070600). In T2DM patients the prevalence of osteoporosis was 25% and low trauma vertebral (Vfx) and non-vertebral fractures were found in 8% and 19% women, respectively. When compared between subjects with and without fractures, there were no significant differences in BMD at any site between the groups, except for distal radius, which was significantly lower in T2DM women with Vfx (p<0.05 vs.non-fractured without osteoporosis). We found no associations between bone and glucose metabolism variables, sRAGE and BMD. No significant differences were observed in sRAGE levels according to their rs1800625, rs 2070600 genotype or fracture prevalence. Serum osteocalcin was significantly lower in T2DM women (p<0.01 vs. controls) and in T2DM women with Vfx (p<0.05) vs. non-fractured without osteoporosis. T2DM women with low daily walking activity (< 2 h daily) had significantly higher serum sclerostin levels (p<0.05 vs. those who were walking > 2 h daily). Diabetes-specific parameters as well as RAGE polymorphisms did not associate with BMD or fractures in T2DM postmenopausal women. Lower levels of osteocalcin, namely in those with Vfx and higher sclerostin levels in those with low daily walking activity suggest lower bone remodeling and/or decreased bone quality in T2DM.

Abstract TP160: Predicting Bone Fracture After Stroke—The Fracture Risk After Ischemic Stroke (FRAC-Stroke) Score

Background: Risk for low trauma fracture is increased by &gt;30% after ischemic stroke. Additionally, in the IRIS trial pioglitazone therapy prevented ischemic stroke but increased fracture risk. We derived a risk score to predict risk of fracture one year after ischemic stroke. Methods: The Fracture Risk after Ischemic Stroke (FRAC-Stroke) Score was derived in 20,435 ischemic stroke patients from the Ontario Stroke Registry discharged from 2003-2012, using Fine-Gray competing risk regression. Candidate variables were medical conditions included in the validated World Health Organization FRAX risk score complemented by variables related to stroke severity. Registry patients were linked to population-based Ontario health administrative data to identify low trauma fractures (defined as any fracture of the femur, forearm, humerus, pelvis or vertebrae, excluding fractures resulting from trauma, motor vehicle accidents, falls from a height or in people with active cancer). The score was externally validated in 13,698 other ischemic stroke patients in the population-based Ontario stroke audit (2002-2012). Results: Mean age was 72; 42% were women. Low trauma fracture occurred within 1 year of discharge in 741/20435 (3.6%); cumulative incidence increased linearly throughout follow-up. Age, discharge modified Rankin score (mRS), and history of arthritis, osteoporosis, falls and previous fracture contributed significantly to the model. Model discrimination was good (c statistic 0.72). Including discharge mRS significantly improved discrimination (relative integrated discrimination index 8.7%). Fracture risk was highest in patients with mRS 3 and 4 but lowest in bedbound patients (mRS 5). From the lowest to the highest FRAC-Stroke quintile the cumulative incidence of 1-year low trauma fracture increased from 1% to 9%. Predicted and observed rates of fracture were similar in the external validation cohort. Conclusion: The FRAC-Stroke score allows the clinician to identify ischemic stroke patients at higher risk of low trauma fracture within one year. This information might be used to target patients for early bone densitometry screening to diagnose and manage osteoporosis, and to estimate baseline risk prior to starting pioglitazone therapy.

Brain Function Associated with Cooccurring Trauma and Depression Symptoms in College Students

ABSTRACTThe goal of this pilot study was to determine if functional brain differences are present among individuals with high and low cooccurring trauma and depression symptoms. This pilot study examined how the P300 latency component of event-related potentials (ERPs), measured using electroencephalography (EEG) while participants performed a go/no-go task, might be associated with cooccurring self-report of trauma and depression symptoms in a sample of college students (N = 38). Alpha-corrected independent sample t tests revealed statistically significant differences in ERP P300 peak latencies between those in the high cooccurring trauma and depression symptoms group (n = 12) and those in the low group (n = 26) for all 3 midline electrode sites (Fz, Cz, and Pz). This pilot study provides preliminary evidence of differential brain functioning in individuals experiencing cooccurring trauma and depression symptoms. Accordingly, these findings support future research examining brain functioning in cooccurring symptoms.

Evaluation of the first fracture liaison service in the Greek healthcare setting.

The purpose of this study was to evaluate the first implementation of a fracture liaison service (FLS) in Greece, at the 251 Hellenic Air Force and VA General Hospital, Athens. Single-center, prospective study from May 1, 2013 to April 30, 2015 (first year-second year follow-up) was conducted. Patients of both genders aged 40-90years old, with a history of a low trauma fracture and willing to participate, were included after identification by an FLS nurse. Following recruitment, osteoporosis risk factors were assessed, FRAX score was calculated for treatment-naïve patients, bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA), and osteoporosis treatment was suggested where applicable. The rate of participation, the indication of osteoporosis treatment, and the difficulties met were evaluated. Of the eligible 213 patients, 97 (45.5%) were reluctant to participate for personal reasons. From the 116 initially recruited patients (mean age 74.8±12years), 77 (66.4%) discontinued their participation at some point for various reasons and 39 patients concluded the study. All 116 patients were assessed for osteoporosis risk factors and given a tailor-made exercise and education program, while FRAX score was assessed in all treatment-naïve patients (74 patients, 63.8%). Osteoporosis medication was suggested or reviewed in 74 patients; however, an adherence rate of 100% is only available for the 24 who concluded the study. We report the first implementation of FLS in the Greek healthcare setting. The participation rate is moderate and definitely needs improvement.