G. Zinger 1, N. Sylvetsky 2, A. Peyser 1

1Shaare Zedek Medical Center/Department of Orthopedics, Jerusalem, Israel,2 Shaare Zedek Medical

Center/Department of Endocrinology, Jerusalem, Israel

Objective:

Our orthopedic department started a secondary fracture prevention program using the successful fracture liaison service (FLS) model. The objectives of this study are to share the clinical benefits to the patients of having an FLS system and estimate the sensitivity of fracture prediction tools.

Materials and Methods

A prospective study was done evaluating patients with fragility fractures of the hip. Evaluation included the following labs: calcium level, albumin level, thyroid function, liver and kidney function and parathyroid hormone (PTH) level when indicated.

During their hospitalization a dual-energy x-ray absorptiometry (DEXA) scan was performed and fracture risk assessment tool (FRAX) was calculated. The results of DEXA and FRAX separately and together were analyzed to determine how well the fragility fracture could have been predicted.

Results – 180 patients are included in this analysis:

12 patients (6.7%) had labs that showed an underlying potentially treatable cause for their weak bone – 7 had high PTH levels and 5 had low TSH levels. 36 patients (20%) had labs that changed their treatment: 4 had low calcium levels that needed correction, 17 had elevated TSH levels and were started on thyroid supplement, and 15 had a new diagnosis of reduced kidney function.

Overall 27% of patients had labs that were clinically important.

FRAX scores:

Major osteoporotic fracture was correctly predicted in only 49%

Hip fracture was predicted in 83%

DEXA scores:

Showed osteoporosis in only 46% of hips

Showed osteoporosis in only 26% of spines

Taking the two most specific measures, hip FRAX and hip DEXA:

Requiring only one OR the other measure to be abnormal, would have predicted a fragility fracture 93% of the time.

Conclusions

1. Laboratory evaluation in patients with a fragility fracture of the hip had significant benefit to 27% of the patients including identifying an underlying treatable cause or providing benefit to their overall health.

2. Hip FRAX was more predictive of a hip fracture than major osteoporotic prediction (p<0.0001).

3. DEXA showed osteoporosis more often in hip than in spine (p<0.023).

4. The combination of FRAX hip score and DEXA hip was the most sensitive in identifying the risk of a potential osteoporotic fracture.