Fracture Liaison Service (FLS) is Associated with Lower Subsequent Fragility Fracture Risk and Mortality: NoFRACT (the Norwegian Capture the Fracture Initiative)

Overview

Journal Osteoporos Int

Date 2025 Jan 14

PMID 39808195

Authors

Camilla Andreasen

Cecilie Dahl

Frede Frihagen

Tove T Borgen

Trude Basso

Jan-Erik Gjertsen

Wender Figved

Torbjorn Wisloff

Gunhild Hagen

Ellen M Apalset

Jens M Stutzer

Ida Lund

Ann K Hansen

Frida I Nissen

Ragnar M Joakimsen

Unni Syversen

Erik F Eriksen

Lars Nordsletten

Tone K Omsland

Ashild Bjornerem

Lene Bergendal Solberg

Affiliations

Soon will be listed here.

Abstract

Purpose: Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality.

Methods: The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011-2015) or intervention period (2015-2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated.

Results: A total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83-0.92) and 10% in men (HR 0.90, 95% CI 0.81-0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79-0.86) and 15% in men (HR 0.85, 95% CI 0.81-0.89).

Conclusion: A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

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