Fracture liaison services, zoledronic acid infusion improved osteoporosis treatment rates
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Published results showed integration of fracture liaison and orthopedic services, as well as inpatient zoledronic acid administration, may improve osteoporosis pharmacotherapy rates among patients with fragility fractures.
Researchers systematically consulted the Massachusetts General Hospital fracture liaison service for patients admitted to the orthopedics service with fragility fracture between February 2016 and December 2019. Researchers established initial outpatient follow-up with fracture liaison service in conjunction with the orthopedic postoperative follow-up visit. Patients at risk for failing timely outpatient follow-up received zoledronic acid during the index fracture hospitalization, according to researchers. Researchers considered the percentage of patients with fragility fractures started on pharmacotherapy for osteoporosis, and average length of stay and 30-day readmission rate of patients treated with zoledronic acid as the main outcome measures.
Among 1,240 patients who received inpatient consultations with the Massachusetts General Hospital fracture liaison service, 479 patients experienced prior fragility fractures. Researchers found 11.5% of the 479 patients who experienced a prior fragility fracture were on osteoporosis treatment prior to admission compared with 5.8% of 761 patients who did not have prior fragility fractures. Researchers found the most common type of fracture was hip fracture, which occurred in 60% of the 1,240 patients.
Of the 575 patients scheduled for a combined orthopedics-fracture liaison service postoperative initial output office follow-up, results showed 53.3% kept their appointments, 33.7% of patients canceled and 12.9% of patients did not attend. Researchers found 39% of the 1,060 potentially eligible patients were on pharmacotherapy by the time of the initial postoperative orthopedic follow-up appointment. Researchers also noted 70% of the 589 patients who were eligible for treatment and whose treatment status was known received pharmacotherapy.
Results showed 108 of 114 patients who received inpatient treatment were given zoledronic acid, which included 26% of the 412 patients who had a confirmed treatment initiation. When comparing 60 patients with hip fracture who received zoledronic acid infusion to 106 patients who declined treatment, researchers found no differences in length of stay or 30-day readmission rates.
“Appropriate initiation of zoledronic acid following a fragility fracture during the index hospitalization may be an effective way to facilitate closure of the osteoporosis treatment gap, particularly in those with advanced age and frailty,” the authors wrote.
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