title: Bridging the osteoporosis treatment gap: performance and cost-effectiveness of a fracture liaison service.
abstract: Individuals who sustain fragility fractures are at high risk of refracture. However, osteoporosis treatment rates remain low for these patients. Therefore, we aimed to assess the performance and cost-effectiveness of introducing a fracture liaison service (FLS) into a tertiary hospital. In "nonhospitalized" ambulatory patients who had sustained fragility fractures, we assessed baseline osteoporosis investigation and treatment rates, and subsequently, the impact of introducing an orthopedic osteoporosis policy and an FLS. Outcomes measured were uptake of osteoporosis intervention, patient satisfaction, and quality-adjusted life years (QALYs) gained. QALYs were calculated over 5 years using predicted fracture risks without intervention and estimated fracture risk reduction with intervention. At baseline (n = 49), 2% of ambulatory patients who had sustained fragility fractures underwent dual-energy X-ray absorptiometry (DXA) and 6% received osteoporosis-specific medication. After introduction of an osteoporosis policy (n = 58), 28% were investigated with DXA (p < 0.0001). However, treatment rates were unchanged. An FLS was introduced, reviewing 203 new patients over the inaugural 2 years (mean age [standard deviation], 67 (11) years; 77% female). All underwent DXA, and criteria for osteoporosis and osteopenia were identified in 44% and 40%, respectively. Osteoporosis medications were prescribed to 61% patients (risedronate: 22%, alendronate: 16%, strontium ranelate: 13%, zoledronic acid: 8%, other: 2%). Eighty-five of 90 questionnaire respondents were very satisfied or satisfied with the FLS. With the treatment prescribed over 5 years, we conservatively estimated that this FLS would reduce nonvertebral refractures from 59 to 50, improving QALYs by 0.054 and costing $1716 per patient (incremental cost-effectiveness ratio: $31749). This FLS model improves uptake of osteoporosis intervention guidelines, is popular among patients, and improves cost-effectiveness. Thus, it has the capacity to substantially improve health in a cost-effective way.
authors: Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne (Royal Melbourne Hospital), Parkville, Victoria, Australia. Electronic address: christopher.yates@mh.org.au.
authors: Christopher J
authors: CJ
authors: Yates
authors: Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; School of Pharmacy, University of Limoges, Limoges, France.
authors: Marie-Anne
authors: MA
authors: Chauchard
authors: Melbourne EpiCentre, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia.
authors: Danny
authors: D
authors: Liew
authors: Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors: Andrew
authors: A
authors: Bucknill
authors: Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne (Royal Melbourne Hospital), Parkville, Victoria, Australia.
authors: John D
authors: JD
authors: Wark
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000368:Aged; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D001315:Australia; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000069448:Denosumab; D004164:Diphosphonates / Q000191:economics / Q000627:therapeutic use; D019468:Disease Management; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D009985:Orthopedics; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics; D058866:Osteoporotic Fractures / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D017060:Patient Satisfaction; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation / Q000191:economics; D000068296:Risedronic Acid; D062606:Tertiary Care Centers; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D000077211:Zoledronic Acid
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D013876:Thiophenes; C081587:strontium ranelate; D000069448:Denosumab; D000077211:Zoledronic Acid; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate
keywords: Cost-effectiveness; fracture liaison service; osteoporosis; treatment