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

被引：0

作者：

Andreasen, Camilla ^{[1
,2
]}

Dahl, Cecilie ^{[3
]}

Frihagen, Frede ^{[4
,5
]}

Borgen, Tove T. ^{[6
]}

Basso, Trude ^{[7
]}

Gjertsen, Jan-Erik ^{[8
,9
]}

Figved, Wender ^{[5
,10
]}

Wisloff, Torbjorn ^{[5
,11
]}

Hagen, Gunhild ^{[12
]}

Apalset, Ellen M. ^{[13
,14
]}

Stutzer, Jens M. ^{[15
]}

Lund, Ida ^{[16
]}

Hansen, Ann K. ^{[1
,2
]}

Nissen, Frida I. ^{[1
,2
,17
]}

Joakimsen, Ragnar M. ^{[2
,18
]}

Syversen, Unni ^{[19
,20
]}

Eriksen, Erik F. ^{[21
,22
]}

Nordsletten, Lars ^{[5
,16
]}

Omsland, Tone K. ^{[3
]}

Bjornerem, Ashild ^{[2
,17
,23
]}

Solberg, Lene Bergendal ^{[16
]}

机构：

[1] Univ Hosp North Norway, Dept Orthoped Surg, Tromso, Norway

[2] Arctic Univ Norway, Dept Clin Med, Tromso, Norway

[3] Univ Oslo, Inst Hlth & Soc, Dept Community Med & Global Hlth, Oslo, Norway

[4] Ostfold Hosp Trust, Dept Orthoped Surg, Gralum, Norway

[5] Univ Oslo, Inst Clin Med, Oslo, Norway

[6] Vestre Viken Hosp Trust, Drammen Hosp, Dept Rheumatol, Drammen, Norway

[7] St Olavs Univ Hosp, Dept Orthoped Surg, Trondheim, Norway

[8] Haukeland Hosp, Dept Orthoped Surg, N-5021 Bergen, Norway

[9] Univ Bergen, Dept Clin Med, Bergen, Norway

[10] Vestre Viken Hosp Trust, Baerum Hosp, Dept Orthoped Surg, Gjettum, Norway

[11] Akershus Univ Hosp, Hlth Serv Res Unit, Lorenskog, Norway

[12] Norwegian Inst Publ Hlth, Dept Hlth Serv, Oslo, Norway

[13] Haukeland Hosp, Dept Rheumatol, Bergen Grp Epidemiol & Biomarkers Rheumat Dis, Bergen, Norway

[14] Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway

[15] More & Romsdal Hosp Trust, Molde Hosp, Dept Orthoped Surg, Molde, Norway

[16] Oslo Univ Hosp, Div Orthoped Surg, Oslo, Norway

[17] Univ Hosp North Norway, Dept Obstet & Gynecol, N-9038 Tromso, Norway

[18] Univ Hosp North Norway, Dept Med, N-9038 Tromso, Norway

[19] Norwegian Univ Sci & Technol, Dept Clin & Mol Med, Trondheim, Norway

[20] St Olavs Univ Hosp, Dept Endocrinol, Trondheim, Norway

[21] Spesialistsenteret Pilestredet Pk, Oslo, Norway

[22] Univ Oslo, Fac Dent, Oslo, Norway

[23] Oslo Univ Hosp, Norwegian Res Ctr Womens Hlth, Oslo, Norway

来源：

OSTEOPOROSIS INTERNATIONAL | 2025年 / 36卷 / 03期

关键词：

fracture liaison service; fragility fractures; osteoporosis; post-fracture mortality; secondary fracture prevention; stepped-wedge cluster-randomized trial; HIP FRACTURE; OSTEOPOROSIS; WOMEN;

D O I：

10.1007/s00198-024-07376-y

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：501 / 512

页数：12

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