Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Chan CSP (1), Ng KCK (1), Lau TH (1)
Affiliation :
(1)Department of Orthopaedics and Traumatology, Tseung Kwan O Hospital
Introduction :
Osteoporosis is a prevalent age-related disease in Hong Kong, which is experiencing rapid population aging. This presents a significant challenge to the healthcare system. Osteoporosis increases the risk of fragility fractures, which commonly occur in the hip, vertebral column, and forearm due to low bone mineral density. Hip fractures pose a significant concern among the elderly population in Hong Kong. These fractures are associated with substantial morbidity, mortality rates, and functional impact, leading to a decrease in quality of life and independence. Without new interventions, the number of incident hip fractures would be expected to double by 2050, further burdening public health. Effective prevention strategies and interventions during the critical two-year period following a hip fracture are essential to mitigate the public health burden and improve the quality of life for affected individuals.
Objectives :
The management of imminent fractures in hip fracture patients has gained significant attention due to the functional impact and healthcare resource demands associated with these fractures. One strategy that has shown promise is the implementation of a Fracture Liaison Service (FLS). The FLS is considered one of the most effective healthcare models for assessing and preventing imminent fractures, as stated in the British Orthopedic Association's Blue Book (2007) on fragility hip fracture care.
The aim of this clinical review study is to provide additional data to evaluate and improve the local implementation of FLS in Hong Kong. By assessing the effectiveness of FLS in preventing imminent fractures and improving osteoporosis management, this study can contribute to enhancing the care provided to fragility fracture patients and reducing the healthcare burden associated with imminent fractures.
Methodology :
Retrospective observational study was performed. The study period included patients admitted to Tseung Kwan O Hospital (TKOH) with a fragility hip fracture between September 17, 2017, and August 16, 2019, who received FLS. These patients were compared with control patients who met the same inclusion and exclusion criteria between September 17, 2016, and August 16, 2017, when FLS was not available.
The study period for each patient extended for 24 months after the diagnosis of hip fracture or until the earliest occurrence of death or the end of data availability. The primary outcome of the study was the rate of imminent fractures within a 2-year follow-up period. The occurrence of imminent fractures was determined from the CMS record, including clinical notes, spine x-rays, and chest x-rays.
Secondary outcomes included the number of patients who underwent follow-up dual-energy X-ray absorptiometry testing, the number of patients initiated on calcium and vitamin D treatment, and the number of patients initiated on anti-osteoporotic medication at 2 years.
Result & Outcome :
A total of 260 patients aged 60 and above with hip fractures were screened. The majority of patients were women, with no significant difference between the two groups (68.6% in FLS group versus 62.9% in pre-FLS group; p = 0.664). The mean age was 75.97 ± 6.6 in the FLS group and 77.45 ± 8.1 in the pre-FLS group (p = 0.120).
No significant differences were found in the demographic data between the FLS and pre-FLS groups.
Univariable analysis comparing the FLS and pre-FLS groups on imminent fracture, DXA testing rate, calcium and vitamin D initiation, and anti-osteoporotic medication initiation showed significant differences in all four measures. The FLS group had a lower percentage of imminent fractures, higher DXA testing rate, and greater initiation of calcium, vitamin D, and anti-osteoporotic medication compared to the pre-FLS group.
The Kaplan-Meier curve demonstrated that patients in the pre-FLS group had a higher cumulative risk of imminent fracture compared to the FLS group, particularly after the first year following the index fracture. The multivariable Cox regression analysis identified age as a significant predictor of imminent fracture, with older age associated with an increased risk.
In conclusion, the implementation of FLS was associated with improved patient outcomes in terms of lower imminent fracture risk, higher DXA testing rate, and increased initiation of calcium, vitamin D, and anti-osteoporotic medication. Age was identified as a significant predictor of imminent fracture. Further investigation is warranted to explore the impact of FLS on patient outcomes in more detail.
