Implementation of a fracture liaison service for patients with hip fracture cared for on a hospital medicine service

Hip fracture is a common and morbid condition. Prior studies have shown that the majority of patients with fragility fracture are not treated for underlying osteoporosis. Our hospitalist-led co-management service for patients with acute hip fracture had no system for evaluating and treating osteoporosis in this cohort. Our objective was to implement a fracture liaison service (FLS) to assist patients with acute hip fracture and assess subsequent impact on diagnosis and treatment of osteoporosis. We conducted a pre-post study design at our tertiary academic center, including patients >50 years old hospitalized with acute hip fracture. We implemented a FLS, whereby all patients received endocrinology consultation. Outcome measures included the proportion of patients evaluated for osteoporosis by time of hospital discharge, comparing pre-implementation (12 months) and post-implementation (9 months) cohorts. We also measured the proportions of patients evaluated for and offered treatment for osteoporosis within 3 months of discharge for patients with post-discharge encounters visible in the medical record. We identified 167 patients before and 124 after FLS implementation. In univariate analysis, the proportion of patients evaluated for osteoporosis before discharge increased from 0.6% to 72.6% (p Establishment of an FLS partnered with a hospitalist-led co-management service for patients with hip fracture was associated with significant improvements in the proportions of patients evaluated and offered treatment for osteoporosis. Wider adoption of this model has the potential to improve care for patients with hip fracture by narrowing the osteoporosis treatment gap.

髋部骨折是一种常见且致残性较高的疾病。既往研究显示，绝大多数脆性骨折患者未针对其潜在的骨质疏松症接受治疗。我院由住院医师（hospitalist）牵头的急性髋部骨折患者联合管理服务，此前未建立针对该队列患者的骨质疏松症评估与治疗体系。本研究旨在推行骨折联络服务（fracture liaison service, FLS），为急性髋部骨折患者提供支持，并评估该服务对骨质疏松症诊断与治疗的后续影响。
本研究于我院三级学术医疗中心开展，采用前后对照研究设计，纳入年龄＞50岁、因急性髋部骨折住院的患者。我们推行了骨折联络服务（FLS），所有患者均可获得内分泌科会诊。结局指标包括患者出院前完成骨质疏松症评估的比例，对比干预前（12个月）与干预后（9个月）两个队列的情况。对于病历中可查询到出院后随访记录的患者，本研究还统计了其出院后3个月内完成骨质疏松症评估及获得治疗方案的比例。
本研究共纳入干预前患者167例，干预后患者124例。单变量分析结果显示，患者出院前完成骨质疏松症评估的比例从0.6%提升至72.6%（p针对髋部骨折患者，联合住院医师牵头的联合管理服务推行骨折联络服务（FLS），可显著提升患者完成骨质疏松症评估及获得治疗方案的比例。该模式的进一步推广，有望通过缩小骨质疏松症治疗缺口，改善髋部骨折患者的诊疗质量。