Fracture liaison service evaluation during admission for fragility femur fracture increases rates of bone health intervention and outpatient follow-up

Alex J Demers; Lori S Fitton; Steele M L McCulley; Irving Delgado-Arellanes; Aspen C Miller; Natalie A Glass; J Lawrence Marsh; Michael C Willey

doi:10.1007/s00198-025-07557-3

Fracture liaison service evaluation during admission for fragility femur fracture increases rates of bone health intervention and outpatient follow-up

Osteoporos Int. 2025 Jun 27. doi: 10.1007/s00198-025-07557-3. Online ahead of print.

Authors

Alex J Demers¹, Lori S Fitton², Steele M L McCulley², Irving Delgado-Arellanes², Aspen C Miller², Natalie A Glass², J Lawrence Marsh², Michael C Willey²

Affiliations

¹ Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 701 W. Forevergreen Road, North Liberty, IA, 52317, USA. alex-demers@uiowa.edu.
² Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 701 W. Forevergreen Road, North Liberty, IA, 52317, USA.

PMID: 40576721
DOI: 10.1007/s00198-025-07557-3

Abstract

This study evaluates the impact of FLS evaluation during hospital admission for fragility femur fracture on rates of bone health intervention. Patients receiving an inpatient evaluation had higher rates of clinic follow-up, outpatient osteoporosis medication initiation, nutritional supplementation, and DXA acquisition. Inpatient FLS evaluations improve rates of post-injury bone health care.

Purpose: Fracture liaison services (FLS) can be effective for secondary fracture prevention; however, patient identification and successful follow-up in clinic remain challenging. This study aims to (1) evaluate the impact of FLS evaluation during hospital admission for fragility femur fracture on rates of bone health interventions and outpatient follow-up, (2) compare post-fracture complication rates associated with FLS evaluation, and (3) identify factors predicting outpatient follow-up attendance.

Methods: Retrospective review identified patients 50 years and older undergoing operative fixation of a femur fracture at a level I academic trauma center from January 1, 2021, to June 1, 2022. Patients were stratified by inpatient FLS evaluation. Clinic follow-up, DXA acquisition, nutritional interventions, osteoporosis medication initiation, and complications were documented up to 1 year postoperatively. Statistical analyses were performed with an α $\leq$ 0.05.

Results: Two hundred thirty-three patients met inclusion criteria, with 54.9% receiving an inpatient FLS evaluation. Patients with an evaluation were more likely to be referred (95% vs. 22%, p < 0.0001) and present (54% vs. 17%, p < 0.0001) to the bone health clinic and have higher rates of vitamin D (95% vs. 41%, p < 0.0001), calcium (88% vs. 35%, p < 0.0001), and protein supplementation (66% vs. 29%, p < 0.0001), DXA acquisition (51% vs. 14%, p < 0.0001), and outpatient osteoporosis medication prescription (38% vs. 17%, p = 0.0003). There was no difference in rates of refracture, subsequent fracture, nonunion, or mortality. Younger patients had increased outpatient clinic attendance.

Conclusion: Inpatient FLS evaluation during hospital admission for fragility femur fracture increases rates of bone health clinic follow-up, osteoporosis intervention, and DXA scan acquisition.

Keywords: Bone health; Femur fracture; Fracture liaison service; Osteoporosis.