title: Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality.
abstract: BACKGROUND
  A fracture liaison service model of care is widely recommended and applied, but data on its effectiveness are scarce. Therefore, the risk of subsequent nonvertebral fractures and mortality within two years after a nonvertebral fracture was analyzed in patients who presented to a hospital with a fracture liaison service and a hospital without a fracture liaison service.
  
  
  METHODS
  In 2005 to 2006, all consecutive patients with an age of fifty years or older presenting with a nonvertebral fracture were included. In the group that presented to a hospital without a fracture liaison service (the no-FLS group), only standard fracture care procedures were followed to address proper fracture-healing. In the group that presented to a hospital with a fracture liaison service (the FLS group), dual x-ray absorptiometry scans and laboratory testing were performed, and if applicable, patients were treated according to the Dutch guideline for osteoporosis. The risk for subsequent nonvertebral fracture and mortality were analyzed using multivariable Cox regression models with adjustments for age, sex, and baseline fracture location.
  
  
  RESULTS
  In total, 1412 patients presented to the fracture liaison service (73.2% were women, and the mean age was 71.1 years), and 1910 underwent standard fracture care (69.8% were women, and the mean age was 69.5 years). After adjustment for age, sex, and baseline fracture location, patients who attended the fracture liaison service had a significantly lower mortality risk (hazard ratio: 0.65; 95% confidence interval [CI]: 0.53 to 0.79) over two years of follow-up. The subsequent nonvertebral fracture risk was also significantly lower in the patients in the FLS group, but this effect was time-dependent, with a hazard ratio of 0.84 (95% CI: 0.64 to 1.10) at twelve months and 0.44 (95% CI: 0.25 to 0.79) at twenty-four months.
  
  
  CONCLUSIONS
  Patients seen at the fracture liaison service had a significantly lower mortality and subsequently a lower risk of nonvertebral fracture than those not seen at the fracture liaison service, with a reduction of 35% and 56%, respectively, over two years of follow-up. A fracture liaison service appears to be a successful approach to reduce the number of subsequent fractures and premature mortality in this cohort of patients.
authors.affiliation: Departments of Trauma Surgery (K.M.B.H. and P.R.G.B.), Rheumatology (P.P.G.), and Orthopedics (P.W.), Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail address for K.M.B. Huntjens: k.huntjens.
authors.forename: Kirsten M B
authors.initials: KM
authors.lastname: Huntjens
authors.affiliation: Departments of General Practice (T.A.C.M.v.G. and J.A.E.) and Statistics (B.W.), Maastricht University. P. Debyelaan 1, 6229 HA Maastricht, The Netherlands.
authors.forename: Tineke A C M
authors.initials: TA
authors.lastname: van Geel
authors.affiliation: Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands.
authors.forename: Joop P W
authors.initials: JP
authors.lastname: van den Bergh
authors.affiliation: Department of Trauma Surgery, Isala Klinieken, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Svenhjalmar
authors.initials: S
authors.lastname: van Helden
authors.affiliation: Departments of Trauma Surgery (K.M.B.H. and P.R.G.B.), Rheumatology (P.P.G.), and Orthopedics (P.W.), Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail address for K.M.B. Huntjens: k.huntjens.
authors.forename: Paul
authors.initials: P
authors.lastname: Willems
authors.affiliation: Departments of General Practice (T.A.C.M.v.G. and J.A.E.) and Statistics (B.W.), Maastricht University. P. Debyelaan 1, 6229 HA Maastricht, The Netherlands.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.affiliation: Departments of General Practice (T.A.C.M.v.G. and J.A.E.) and Statistics (B.W.), Maastricht University. P. Debyelaan 1, 6229 HA Maastricht, The Netherlands.
authors.forename: John A
authors.initials: JA
authors.lastname: Eisman
authors.affiliation: Departments of Trauma Surgery (K.M.B.H. and P.R.G.B.), Rheumatology (P.P.G.), and Orthopedics (P.W.), Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail address for K.M.B. Huntjens: k.huntjens.
authors.forename: Piet P
authors.initials: PP
authors.lastname: Geusens
authors.affiliation: Departments of Trauma Surgery (K.M.B.H. and P.R.G.B.), Rheumatology (P.P.G.), and Orthopedics (P.W.), Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail address for K.M.B. Huntjens: k.huntjens.
authors.forename: Peter R G
authors.initials: PR
authors.lastname: Brink
mesh_terms: D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006296:Health Services; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods*; D010024:Osteoporosis / Q000453:epidemiology* / Q000401:mortality; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D055502:Secondary Prevention