Osteoporosis Treatment after Fragility Fractures of the Hip: A Secondary Prevention Program

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 medications to treat the underlying osteoporosis but we need a better system to get patients started on the correct treatment. The fracture liaison service (FLS) is a coordinator-based fracture prevention service for the treatment of osteoporotic patients. This study uses the FLS model to show that an effective treatment program is possible in the Israeli national health care system.

Methods: At Shaare Zedek Medical Center, we performed a prospective randomized study to show the effectiveness of an intervention program. The control group was given a letter at the time of discharge instructing them to discuss evaluation and treatment with their physician. The other group had 4 interventions: patients were given information about osteoporosis, a DEXA scan was performed, patients were given a specific medication recommendation to give to their physician, and monthly calls were made by the FLS coordinator. The primary outcome measure was whether the patient was on correct treatment, as defined by our endocrinologist, at 4 months post-fracture

Results: Approximately one year after starting the study, there were 404 patients with hip fractures of which approximately 50% were eligible and 71% of those eligible were enrolled. To date, 162 patients were randomized into control versus intervention.

At 4 months post-fracture, only 6% of control patients were on correct treatment versus 83% of the intervention group – a statistically significant difference, shown by chi square test (χ²₍₁₎=73.71, p<.001).

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 predetermined protocol. We show that in Israel such a system is effective.