Authors (including presenting author) :
Man KH(1)(2), Law HK(1)(2), Yu LF(1)(2), Wong KK(1)(2)
Affiliation :
(1)Department of Orthopaedics and Traumatology, (2)Kwong Wah Hospital
Introduction :
The aging problem means a higher population is suffering from osteoporosis, hence increases of fragility fractures and burden on our medical system. Fracture Liaison Service (FLS) is the way to tackle this problem. It has been implemented in the Orthopaedics & Traumatology Department (O&T) of Kwong Wah Hospital (KWH) since the fourth quarter of 2019. It is a coordinator-based, multidisciplinary service to improve the care of fragility fractures from the acute to rehabilitation phase and strive to reduce the risk of subsequent fractures.
Objectives :
This study aims to evaluate the FLS outcome in 2022 based on criteria of the international standards & the clinical effectiveness of FLS by the one-year outcome.
Methodology :
Patients above 65 years old with fragility fractures were recruited into FLS in O&T in KWH from January to December 2022. Major outcomes were evaluated from two perspectives with service and patient’s outcome.
Result & Outcome :
In 2022, 357 patients (186 Hip, 105 Spine, 13 Major limbs, mean age 82.8±9.8) were recruited. The rate of identification of fragility fracture was improved significantly compared with 2018 and 2022 (Hip, 63.5% versus 100%, p<0.05, fisher exact test) (Spine & major limbs, 0% versus 100%, p<0.0001, fisher exact test). All patients (n=357) received ortho-geriatric co-management (100% versus 3.5% in local study, p<0.0001, fisher exact test). The consultation time of the ortho-geriatrician was significantly shortened from 3.47 to 0.31 days (p<0.0001, Mann Whitney U test). The post fracture assessment by FLS screening, FRAX assessment and radiology examination were within three days. Patients with dental caries received dental assessment within eight weeks. 75.6% of hip (n=49), 42.8% of spine (n=45), and 70% of major limbs (n=7) from the total number of cases with suggested treatments were commenced anti-osteoporotic medications. The overall drug compliance rate was 92.5% The patient’s outcomes showed regular calcium and vitamin D intake and regular exercise >30 minutes were 97.6% and 39.1%. The Follow-up attendance rate was 88.2% compared to 74.8% in the local study. The overall rate of secondary fall significantly decreased 58% (6% versus 61%, p <0.001, Fisher exact test). The Fracture liaison service facilitates the effectiveness of clinical outcomes and enhances the secondary prevention of fragility fracture. In 2022, the service was awarded a silver standard in Best Practice Framework Evaluation by the International Osteoporosis Foundation (IOF).
