Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative).

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Osteoporosis International Pub Date : 2025-01-14 DOI:10.1007/s00198-024-07376-y

Camilla Andreasen, Cecilie Dahl, Frede Frihagen, Tove T Borgen, Trude Basso, Jan-Erik Gjertsen, Wender Figved, Torbjørn Wisløff, Gunhild Hagen, Ellen M Apalset, Jens M Stutzer, Ida Lund, Ann K Hansen, Frida I Nissen, Ragnar M Joakimsen, Unni Syversen, Erik F Eriksen, Lars Nordsletten, Tone K Omsland, Åshild Bjørnerem, Lene Bergendal Solberg

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Abstract

Subsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures.

Purpose: Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality.

Methods: The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011-2015) or intervention period (2015-2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated.

Results: A total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83-0.92) and 10% in men (HR 0.90, 95% CI 0.81-0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79-0.86) and 15% in men (HR 0.85, 95% CI 0.81-0.89).

Conclusion: A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

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骨折联络服务（FLS）与随后的脆性骨折风险和死亡率较低相关：NoFRACT（挪威捕获骨折倡议）。

在引入骨折联络服务（FLS）前后，比较了随后的骨折发生率和相关死亡率。在100,198名女性和男性中，FLS与随后的脆性骨折风险降低13%和10%以及死亡率降低18%和15%相关。研究表明，FLS可以预防骨折。目的：有效的裂缝预防策略是控制全球裂缝负荷的必要措施。我们调查了标准化骨折联络服务（FLS）干预对后续骨折风险和死亡率的影响。方法：NoFRACT研究被设计为一项多中心、实用、注册支持、楔步聚类随机试验。从2015年5月到2018年12月，FLS干预分为三个组，间隔4个月，包括对50岁以上低能骨折患者的骨质疏松症和治疗的评估。根据挪威患者登记处的数据，根据骨折时间将指数骨折患者分配到对照期（2011-2015年）或干预期（2015-2018年）。计算随后脆性骨折（前臂远端、肱骨近端或髋关节）的发生率和全因死亡率。结果：共有100,198例患者（平均年龄69.6岁）发生任何类型的指数骨折。在最长4.7年的随访期间，11%（6948）的女性和6%（2014）的男性经历了随后的脆性骨折，20%（14324）的女性和22%（8326）的男性死亡。FLS与女性脆性骨折风险降低13%（风险比（HR） 0.87, 95%可信区间（CI） 0.83-0.92）、男性脆性骨折风险降低10% （HR 0.90, 95% CI 0.81-0.99）、女性死亡率降低18% （HR 0.82, 95% CI 0.79-0.86）、男性死亡率降低15% （HR 0.85, 95% CI 0.81-0.89）相关。结论：标准化的FLS干预与随后脆性骨折和死亡率的降低相关，并可能有助于减少全球骨折负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Osteoporosis International 医学-内分泌学与代谢

CiteScore

8.10

自引率

10.00%

发文量

224

审稿时长

3 months

期刊介绍： An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.