title: Optimizing fracture prevention: the fracture liaison service, an observational study.
abstract: The response rate to the invitation to the fracture liaison service and reasons for non-response were evaluated in 2,207 fragility fracture patients. Fifty-one percent responded; non-responders were most often not interested (38 %) or were hip fracture patients. After 1 year of treatment, 88 % was still persistent and 2 % had a new fracture.
  
  
  BACKGROUND
  To increase the percentage of elderly fracture patients undergoing a dual energy x-ray absorptiometry (DXA) measurement, and to investigate why some patients did not respond to invitation to our fracture liaison service (FLS).
  
  
  METHODS
  In four Dutch hospitals, fracture patients ≥ 50 years were invited through a written or personal invitation at the surgical outpatient department, for a DXA measurement and visit to our FLS. Patients who did not respond were contacted by telephone. In patients diagnosed with osteoporosis, treatment was started. Patients were contacted every 3 months during 1 year to assess drug persistence and the occurrence of subsequent fractures.
  
  
  RESULTS
  Of the 2,207 patients who were invited, 50.6 % responded. Most frequent reasons for not responding included: not interested (38 %), already screened/under treatment for osteoporosis (15.7 %), physically unable to attend the clinic (11.5 %), and death (5.2 %). Hip fracture patients responded less frequently (29 %) while patients with a wrist (60 %) or ankle fracture (65.2 %) were more likely to visit the clinic. In 337 responding patients, osteoporosis was diagnosed and treatment was initiated. After 12 months of follow-up, 88 % of the patients were still persistent with anti-osteoporosis therapy and only 2 % suffered a subsequent clinical fracture.
  
  
  CONCLUSIONS
  In elderly fracture patients, the use of a FLS leads to an increased response rate, a high persistence to drug treatment, and a low rate of subsequent clinical fractures. Additional programs for hip fracture patients are required, as these patients have a low response rate.
authors.affiliation: Department of Rheumatology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands, d.eekman@vumc.nl.
authors.forename: D A
authors.initials: DA
authors.lastname: Eekman
authors.forename: S H
authors.initials: SH
authors.lastname: van Helden
authors.forename: A M
authors.initials: AM
authors.lastname: Huisman
authors.forename: H J J
authors.initials: HJ
authors.lastname: Verhaar
authors.forename: I E M
authors.initials: IE
authors.lastname: Bultink
authors.forename: P P
authors.initials: PP
authors.lastname: Geusens
authors.forename: P
authors.initials: P
authors.lastname: Lips
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D055118:Medication Adherence; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D010044:Outpatient Clinics, Hospital; D011314:Preventive Health Services / Q000458:organization & administration*
chemical_list: D050071:Bone Density Conservation Agents
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