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Aging Clin Exp Res. 2018 Oct 11. doi: 10.1007/s40520-018-1054-2. [Epub ahead of print]

The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly.

Author information

1
Department of Orthopaedic Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. ilknursanli@hotmail.com.
2
Department of Trauma Surgery, Isala Clinics Zwolle, Zwolle, The Netherlands.
3
Department of Orthopaedic Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
4
Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
5
Department of Internal Medicine, Viecuri Medical Centre of Noord Limburg, Venlo, The Netherlands.
6
Department of Trauma Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.

Abstract

BACKGROUND:

Several guidelines recommend a bone and fall-related osteoporosis risk assessment in all patients with fracture and age > 50 years. In practice, however, there is no consensus whether screening > 85 years is useful.

AIM:

To evaluate the subsequent fracture risk in all patient > 85 years, comparing the two populations of Fracture Liaison Service (FLS) attenders and non-attenders.

METHODS:

All patients > 85 years that presented at the FLS with a non-vertebral fracture were included in the study during a 5-year period (September 2004 and December 2009). Excluded were pathologic fractures, death < 30 days, or patients on osteoporosis treatment. in patients that attended the FLS, assessment of bone mineral density and fall-risk factors were screened. In both the attenders and non-attenders groups, mortality and subsequent fracture rates were scored during a follow-up of 2 years.

RESULTS:

282 patients fulfilled inclusion criteria for screening, of which 160 (57%) patients did not attend the FLS. 122 patients were screened for osteoporosis and fall-related risk of whom 72 were diagnosed with osteoporosis. Subsequent fracture risk in both groups was 19%. Medical treatment was started in 51 patients, of which 15 patients developed a subsequent fracture. Cox-regression analysis indicated a significantly lower mortality rate, but not a diminished subsequent fracture rate in the FLS screened population compared to the non-attenders.

CONCLUSION:

The advantage of a FLS in reducing subsequent fracture risk in patients > 85 years seems to be limited. In practice a large proportion of these patients are not screened.

KEYWORDS:

Extreme elderly; FLS; Osteoporosis; Subsequent fracture

PMID:
30311093
DOI:
10.1007/s40520-018-1054-2

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