Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis

Chih Hsing Wu, Shih Te Tu, Yin Fan Chang, Ding Cheng Chan, Jui Teng Chien, Chih Hsueh Lin, Sonal Singh, Manikanta Dasari, Jung Fu Chen, Keh Sung Tsai

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives: This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. Methods: Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000–February 2017 inclusive) using the keywords ‘osteoporosis’, ‘fractures’, ‘liaison’, and 'service’ to identify randomised controlled trials and observational studies of patients aged ≥50 years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. Results: A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0% vs 23.5%) and treatment initiation (38.0% vs 17.2%) and greater adherence (57.0% vs 34.1%). Unweighted average rates of re-fracture were 13.4% among patients in the control arm and 6.4% in the FLS arm. Unweighted average rates of mortality were 15.8% in the control arm and 10.4% in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95% confidence interval [CI] 0.18–0.29), 20 percentage points for treatment rates (95% CI 0.16–0.25), and 22 percentage points for adherence (95% CI 0.13–0.31) and absolute risk of re-fracture reduced by five percentage points (95% CI –0.08 to −0.03) and mortality reduced by three percentage points (95% CI –0.05 to −0.01). Conclusion: FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.

Original languageEnglish
Pages (from-to)92-100
Number of pages9
JournalBone
Volume111
DOIs
Publication statusPublished - 2018 Jun

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Osteoporosis
Meta-Analysis
Bone Density
Confidence Intervals
Observational Studies
Mortality
Therapeutics
Incidence
PubMed
Libraries
Publications
Patient Care
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Physiology
  • Histology

Cite this

Wu, Chih Hsing ; Tu, Shih Te ; Chang, Yin Fan ; Chan, Ding Cheng ; Chien, Jui Teng ; Lin, Chih Hsueh ; Singh, Sonal ; Dasari, Manikanta ; Chen, Jung Fu ; Tsai, Keh Sung. / Fracture liaison services improve outcomes of patients with osteoporosis-related fractures : A systematic literature review and meta-analysis. In: Bone. 2018 ; Vol. 111. pp. 92-100.
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title = "Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis",
abstract = "Objectives: This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. Methods: Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000–February 2017 inclusive) using the keywords ‘osteoporosis’, ‘fractures’, ‘liaison’, and 'service’ to identify randomised controlled trials and observational studies of patients aged ≥50 years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. Results: A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0{\%} vs 23.5{\%}) and treatment initiation (38.0{\%} vs 17.2{\%}) and greater adherence (57.0{\%} vs 34.1{\%}). Unweighted average rates of re-fracture were 13.4{\%} among patients in the control arm and 6.4{\%} in the FLS arm. Unweighted average rates of mortality were 15.8{\%} in the control arm and 10.4{\%} in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95{\%} confidence interval [CI] 0.18–0.29), 20 percentage points for treatment rates (95{\%} CI 0.16–0.25), and 22 percentage points for adherence (95{\%} CI 0.13–0.31) and absolute risk of re-fracture reduced by five percentage points (95{\%} CI –0.08 to −0.03) and mortality reduced by three percentage points (95{\%} CI –0.05 to −0.01). Conclusion: FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.",
author = "Wu, {Chih Hsing} and Tu, {Shih Te} and Chang, {Yin Fan} and Chan, {Ding Cheng} and Chien, {Jui Teng} and Lin, {Chih Hsueh} and Sonal Singh and Manikanta Dasari and Chen, {Jung Fu} and Tsai, {Keh Sung}",
year = "2018",
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Fracture liaison services improve outcomes of patients with osteoporosis-related fractures : A systematic literature review and meta-analysis. / Wu, Chih Hsing; Tu, Shih Te; Chang, Yin Fan; Chan, Ding Cheng; Chien, Jui Teng; Lin, Chih Hsueh; Singh, Sonal; Dasari, Manikanta; Chen, Jung Fu; Tsai, Keh Sung.

In: Bone, Vol. 111, 06.2018, p. 92-100.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Fracture liaison services improve outcomes of patients with osteoporosis-related fractures

T2 - A systematic literature review and meta-analysis

AU - Wu, Chih Hsing

AU - Tu, Shih Te

AU - Chang, Yin Fan

AU - Chan, Ding Cheng

AU - Chien, Jui Teng

AU - Lin, Chih Hsueh

AU - Singh, Sonal

AU - Dasari, Manikanta

AU - Chen, Jung Fu

AU - Tsai, Keh Sung

PY - 2018/6

Y1 - 2018/6

N2 - Objectives: This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. Methods: Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000–February 2017 inclusive) using the keywords ‘osteoporosis’, ‘fractures’, ‘liaison’, and 'service’ to identify randomised controlled trials and observational studies of patients aged ≥50 years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. Results: A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0% vs 23.5%) and treatment initiation (38.0% vs 17.2%) and greater adherence (57.0% vs 34.1%). Unweighted average rates of re-fracture were 13.4% among patients in the control arm and 6.4% in the FLS arm. Unweighted average rates of mortality were 15.8% in the control arm and 10.4% in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95% confidence interval [CI] 0.18–0.29), 20 percentage points for treatment rates (95% CI 0.16–0.25), and 22 percentage points for adherence (95% CI 0.13–0.31) and absolute risk of re-fracture reduced by five percentage points (95% CI –0.08 to −0.03) and mortality reduced by three percentage points (95% CI –0.05 to −0.01). Conclusion: FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.

AB - Objectives: This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. Methods: Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000–February 2017 inclusive) using the keywords ‘osteoporosis’, ‘fractures’, ‘liaison’, and 'service’ to identify randomised controlled trials and observational studies of patients aged ≥50 years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. Results: A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0% vs 23.5%) and treatment initiation (38.0% vs 17.2%) and greater adherence (57.0% vs 34.1%). Unweighted average rates of re-fracture were 13.4% among patients in the control arm and 6.4% in the FLS arm. Unweighted average rates of mortality were 15.8% in the control arm and 10.4% in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95% confidence interval [CI] 0.18–0.29), 20 percentage points for treatment rates (95% CI 0.16–0.25), and 22 percentage points for adherence (95% CI 0.13–0.31) and absolute risk of re-fracture reduced by five percentage points (95% CI –0.08 to −0.03) and mortality reduced by three percentage points (95% CI –0.05 to −0.01). Conclusion: FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.

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