ArticleArchives of osteoporosis2026
Risk stratification improves outcomes in an osteoporosis fracture liaison service.
Article in Archives of osteoporosis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Selecting patients at higher baseline risk of fragility fracture may optimise clinical outcomes and cost-effectiveness of hospital fracture liaison services (FLS). In this cohort study, we found a risk-stratified approach led to a higher rate of treatment initiation and estimated number of fractures prevented compared to the traditional FLS strategy. PURPOSE: Hospital-based fracture liaison services (FLS) are cost-effective and reduce refracture risk. However, optimal FLS characteristics to maximise clinical and cost-effectiveness are uncertain.
methodsWe reviewed data for FLS patients at Royal North Shore Hospital, Sydney (2015-2023). In 2018, the patient selection strategy was adjusted from a traditional approach (any fragility fracture, ≥ 50 years) to preferentially invite those either ≥ 60 years with any fragility fracture, or any presenting with hip and/or vertebral fractures. Cohorts entering the service pre-(FLS1) and post-this timepoint (FLS2) were compared regarding clinical characteristics, estimated fracture risk and pharmacotherapy initiation. Modelling was performed to estimate fractures averted.
resultsThe total cohort (n = 1903) was median 68-years-old and predominantly female (77%). Both cohorts were similar in sex distribution and prevalence of various fracture risk factors. The FLS2 cohort was older (median 69 vs 65 years, p < 0.001), more frequently presented with hip/vertebral fracture (21.4% vs 13.8%, p < 0.001), had higher Garvan-estimated 10-year fracture-risk (median 36.0% vs 27.4%, p < 0.001) and more frequently initiated pharmacotherapy (79.0% vs 64.6%, p < 0.001). In the overall cohort, strongest predictors of treatment initiation were older age, osteoporotic bone density, hip/vertebral fracture and female sex. Over 5 years, risk-stratified FLS was estimated to avert more osteoporotic (72 vs 44, p < 0.001) and hip fractures (20 vs 10, p < 0.001) per 1000 patients compared with traditional FLS.
conclusionIn this large hospital-based FLS study, a risk-stratified selection strategy was associated with more frequent pharmacotherapy initiation and estimated to avert more fractures; however, longitudinal assessment of treatment adherence and refracture rates is required to confirm utility.
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