Background/Purpose: Osteoporosis causes significant morbidity and mortality in the elderly. Despite the benefits of treatment, < 25% of elderly patients who fracture receive treatment. A fracture liaison service (FLS) provides a systematic way to address secondary fracture prevention. An FLS was implemented at our county-affiliated hospital. There is limited data overall on FLS Outcomes at county hospital systems where the majority of patients are indigent, and access to services may be limited. A prior study highlighted worse outcomes in our county population vs a university hospital population. The purpose of this study is to determine the impact of an FLS at a county hospital during its first year of implementation on improving osteoporosis treatment initiation and DXA testing and to identify areas of improvement.

Methods: We performed a retrospective electronic medical chart review on 282 patients diagnosed with osteoporosis based on relevant ICD-10 codes; 144 patients were seen prior to (pre-FLS) and 138 patients seen after (post-FLS) the establishment of an FLS. Age, ethnicity, BMI, calcium and vitamin D supplementation, treatment initiation (with bisphosphonates or biologics), DXA testing, and adherence to outpatient follow-up were collected. We used Pearson’s chi-square to test for independence in the demographic and clinical categorical outcome variables while independent samples t-test was used to compare mean differences in the demographic and clinical continuous outcome variables. In the post-FLS group only, we tested treatment initiation, DXA testing, calcium and vitamin D supplementation before admission and after discharge using McNemar’s test statistic. We set alpha equal to 0.05 for statistical significance.

Results: The pre-FLS group tended to be slightly younger (p= 0.022) and had a higher percentage of Hispanics (p= 0.021) than the post-FLS group (Table 1). A higher percentage of the post-FLS group was female (76% vs 67%). Smoking and alcohol-use status, and BMI were independent of FLS group status.

No statistically significant differences in mean length of stay, days until next encounter (any) between FLS subgroups were noted (Table 2). While only 14% of FLS patients were seen in Rheumatology clinic, primary care physicians (PCPs) were notified of patient’s fracture risk via the FLS. In the post-FLS group, more patients were treated (20 additional patients, p=0.004) and prescribed calcium (66 additional patients, p< 0.001) and vitamin D (66 additional patients, p< 0.001) after discharge in paired outcome analysis (Table 3). No statistically significant changes in DXA orders from pre-admission to post-discharge were noted.

Conclusion: Assessment of FLS outcomes highlighted inadequacies in osteoporosis management within the county health system. Interdisciplinary efforts to improve DXA access and PCP awareness of fracture risks are currently underway. Initial efforts have proven successful in increasing the number of patients treated after a fragility fracture in this population.

BMI=Body Mass Index. Percentages are shown by column (Fracture Liaison Service group) and may not add to 100 due to rounding. Based on valid data where missing data varies by characteristic. *p-value based on the chi-square statistic for categorical variables and independent samples t-test for continuous variables, *p-value < 0.05.

For the categorical characteristics, only the “yes” counts and corresponding percentages are shown. Based on valid data where missing data varies by characteristic. *p-value based on the chi-square statistic for categorical variables and independent samples t-test for continuous variables, *p-value < 0.05.

DEXA=Dual-energy X-ray absorptiometry. Percentages add to one-hundred by row. *p-value based on McNemar’s test statistic for paired categorical variables, *p-value < 0.05.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fracture-liaison-service-outcomes-at-a-southern-california-county-hospital-highlights-need-for-health-system-improvements/