Introduction: This systematic literature review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through a fracture liaison service (FLS) programme.
Materials & methods: Medline, PubMed, EMBASE and the Cochrane Library were searched (Jan 2000? Feb 2017 inclusive) using keywords: osteoporosis, fractures, liaison, and service, to identify randomised controlled trials and observational studies. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects or fixed-effects model when appropriate. Settings included hospital, clinic, community or home based. Participants were patients aged ≥50 years with osteoporosis-related fractures. Intervention was FLS. Outcome measures included incidence of re-fractures, mortality, bone mineral density (BMD) testing, treatment initiation and adherence to osteoporosis treatment.
Results: Total of 159 publications were identified for the systematic literature review; 74 controlled studies were included in the meta-analysis. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with absolute risk of re-fracture reduced by 5 percentage points (95% CI ?8% to ?3%; unweighted average re-fracture rate of 6.4% with FLS and 13.4% with non-FLS), mortality rate reduced by 3 percentage points (95% CI ?5% to ?1%; unweighted average mortality rate of 10.4% with FLS and 15.8% with non-FLS), BMD testing rate increased by 24 percentage points (95% CI 18%-29%9; unweighted average rate of 48.1% with FLS and 23.5% with non-FLS), 20 percentage points for treatment rate (95% CI 16%-25%; unweighted average rate of 38.0% with FLS and 17.2% with non-FLS), and 22 percentage points for treatment adherence rate (95% CI 13%-31%; unweighted average rate of 57.0% with FLS and 34.1% with non-FLS).
Conclusions: Fracture liaison services do improve outcomes of osteoporosis-related fractures, with significant reductions in re-fracture incidence and mortality, significant increases in bone mineral density testing, treatment initiation, and treatment adherence.
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