G. Zinger 1, B. Bat-El 1, N. Sylvetsky2, A. Peyser 1

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

2-Shaare Zedek Medical Center/Department of Endocrinology, Jerusalem, Israel

Objective

After a low-energy hip fracture, approximately 20% of people die the first year and 86% of people that survive will ultimately have another fragility fracture. We have effective medication to treat the underlying osteoporosis but we need a better system to get patients on the correct treatment. This study uses the fracture liaison (FLS) model to show that an effective treatment program is possible in a national health care system.

Materials and Methods

At Shaare Zedek Medical Center, Jerusalem, we performed a prospective randomized study to show the effectiveness of an intervention program.

Control group: At the time of discharge, the patient was given a letter instructing them to discuss evaluation and treatment with their family physician.

Intervention group: patients were given printed information about osteoporosis, a DEXA scan was performed during their initial hospitalization, patients were given a specific medication recommendation to give to their physician, and monthly phone calls were made by the FLS coordinator.

The primary outcome measure was whether the patient was on correct treatment, as defined by our national health care guidelines at 4 months post-fracture. The study was powered assuming 20% of control would be on correct treatment versus 50% of the intervention group.

Results

Eighteen months after starting the study, we treated 643 patients with hip fractures of which 305 were eligible. Of those, 200 patients (66%) were enrolled and randomized and we have 4-month data on 180 patients. Our secondary outcome is mortality rate at one year and we have data on 122 of those patients.

Intervention Efficacy:

Control group – on correct treatment = 5/84 (5.9%)

Intervention group – on correct treatment = 64/79 (81%)

Intervention is significantly more effective, P<0.0001

Mortality Rate at one year: overall 16%

On treatment = 2/52 (3.8%)

Off treatment = 18/70 (26%)

Being on treatment is associated with lower mortality, P<0.04

Conclusions

A Secondary prevention program is described where orthopedics takes responsibility for bone health. The most successful programs worldwide have a FLS coordinator that manages evaluation and guides treatment using a pre-determined protocol. We show that in the setting of a national health care system, such a system is effective.