title: Refracture following fracture liaison service assessment illustrates the requirement for integrated falls and fracture services.
abstract: The Fracture Liaison Service (FLS) allows appropriate antiosteoporosis therapy to be targeted to potentially reduce future fracture risk. A proportion of these treated patients will still experience a further fracture. This work reviews the characteristics of these patients. Data were collated for patients >65 years old presenting to the South Glasgow FLS between January 2001 and August 2004. There were 2,489 patients who presented (incident fracture group), and 129 (5.2%) sustained an additional fracture (refracture group). Median age of the incident fracture group was 77.8 years vs. 80.6 years for the refracture group (P = nonsignificant). The refracture group was determined according to whether their incident fracture was hip (n = 47) or nonhip (n = 82). When the incident fracture was hip, a refracture was more likely to be a further hip fracture (chi(2) = 14.4, P = 0.002) and patients refractured sooner (median time to refracture 194 [range 10-1,134] days vs. 258 [range 6-1,081] days [nonhip]) (P = nonsignificant). In the refracture group, 76% of patients were already on osteoporosis treatment after their incident fracture. Patients over 65 years of age presenting to FLS who sustain an additional fracture are older; are likely to sustain another hip fracture after an incident hip fracture; often refracture early, particularly when the incident fracture is of the hip; and are often already on antiosteoporosis treatment. Therefore, it is important to identify these high-risk patients and offer a combined approach of prompt drug treatment through a systematic and specialist osteoporosis management team along with reducing any reversible falls risk factors.
authors.affiliation: Department of Medicine for the Elderly, Southern General Hospital, Langlands Building, 1345 Govan Road, Glasgow, Scotland, UK.
authors.forename: Claire R
authors.initials: CR
authors.lastname: Langridge
authors.forename: Carol
authors.initials: C
authors.lastname: McQuillian
authors.forename: Walter S
authors.initials: WS
authors.lastname: Watson
authors.forename: Barbara
authors.initials: B
authors.lastname: Walker
authors.forename: Lara
authors.initials: L
authors.lastname: Mitchell
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gallacher
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control*; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology*; D010348:Patient Care Team; D011787:Quality of Health Care; D012307:Risk Factors; D012606:Scotland; D055502:Secondary Prevention; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D014807:Vitamin D; D002118:Calcium