Introduction
Material and methods
Study design
FLS procedures
Statistical analysis
Results
FLS | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
Percent (number of patients) | 30.9% (n = 2,224) | 11.8% (n = 847) | 19.6% (n = 1,409) | 23.6% (n = 1,699) | 14.2% (n = 1,020) |
Time period studied (months) | 47 months | 58 months | 52 months | 54 months | 39 months |
Patients/month | 47 | 15 | 27 | 31 | 26 |
Inclusion criteria | ≥50 years, all fracture types | ≥50 years, all fracture types | ≥50 years, all fracture types | ≥50 years, all fracture types | ≥50 years, all fracture types |
Exclusion criteria | Dementia, pathological fracture | Dementia, HET | Dementia, pathological fracture HET | Dementia, pathological fracture HET | Dementia, pathological fracture |
Patient recruitment | E-care system, ED, outpatient clinic, cast clinic | Outpatient clinic, cast clinic, E-care system, ED | Through radiology reports and thereafter contacted by phone | Through radiology reports and thereafter contacted by phone | ED nurse and in hospital patients via surgeon/orthopaedic surgeon |
Fracture location unknown (%) | 3.3 | 4.5 | 0.1 | 0.4 | 0.5 |
Nurse practitioner | No | Yes | No | No | No |
Nurse | Yes | No | Yes | Yes | Yes |
Time per week (hrs) | 7 × 4 | 4 × 4 | 2 × 8 | 2 × 8; 1 × 4 | 3 × 8 |
Counselling | Trauma surgeon, orthopaedic surgeon, internist–rheumatologist | Internist–endocrinologist (by phone) | Internist–endocrinologist | Internist–endocrinologist | Internist, trauma surgeon |
DXA scan | Yes after first visit | Yes before first visit | Yes before first visit | Yes before first visit | Yes before first visit |
No DXA scan results (%) | 12.1 | 17.0 | 1.0 | 0.4 | 9.8 |
Blood examination | Men | T-score <−2.0, osteoporosis | Men <65 years and T-score ≤−2.5; women/men <70 years and T-score ≤−3.0 | Men <65 years and T-score ≤−2.5; women/men <70 years and T-score ≤−3.0 | All patients |
Questionnaire | Nurse | Patient | Patient | Patient | Nurse |
CRFs missing (%) | |||||
Previous fracture ≥50 years | 0 | 0 | 0.3 | 0 | 0 |
Previous vertebral fracture | 0 | 34.6 | 0 | 0 | 0 |
Family history of hip fracture | 0 | 1.7 | 0 | 0 | 0 |
Immobility | 0 | 48.4 | 0 | 0 | 0 |
Low body weight (<60 kg) | 30.5 | 2.5 | 1.6 | 5.7 | 5.3 |
Use of corticosteroids | 0 | 2.5 | 0 | 0 | 0 |
Fall risks missing (%) | |||||
Fall in preceding 12 months | 0 | 56.2 | 0.3 | 0.1 | 100a
|
Fracture due to fall from standing height | 0 | 48.4 | 0 | 0 | 0 |
Implementation of the national osteoporosis guideline at the FLSs Performance
1 | 2 | 3 | 4 | 5 | All | RRa
| P valueb | |
---|---|---|---|---|---|---|---|---|
Age (SD) | 67.5 (10.7) | 69.0 (10.5) | 65.6 (9.3) | 65.4 (9.2) | 67.0 (10.2) | 66.7 (10.0) | <0.001 | |
Sex (%) | <0.001 | |||||||
• Women | 74.2 | 88.2 | 70.0 | 79.9 | 77.0 | 76.7 | ||
• Men | 25.8 | 11.8 | 30.0 | 20.1 | 23.0 | 23.3 | ||
Fracture location (%) | <0.001 | |||||||
• Major | 18.1 | 15.3 | 13.4 | 14.6 | 14.8 | 15.5 | ||
• Minor | 70.3 | 78.5 | 66.3 | 65.5 | 75.9 | 70.1 | ||
• Hip | 5.5 | 5.3 | 7.6 | 7.3 | 1.0 | 5.7 | ||
• Fingers/Toes | 6.1 | 0.9 | 12.6 | 12.6 | 8.4 | 8.7 | ||
• Hip | 5.5 | 5.3 | 7.6 | 7.3 | 1.0 | 5.7 | ||
• Humerus | 13.7 | 12.3 | 9.9 | 11.0 | 14.3 | 12.2 | ||
• Distal radius/ulna | 25.8 | 22.4 | 26.8 | 26.9 | 27.2 | 26.1 | ||
• Tibia/fibula | 12.7 | 12.8 | 13.3 | 12.7 | 12.8 | 12.9 | ||
• Other | 42.3 | 47.1 | 42.4 | 42.1 | 44.7 | 43.2 | ||
BMD (%) | <0.001 | |||||||
• Normal BMD | 23.7 | 5.0 | 26.6 | 15.5 | 30.3 | 21.2 | ||
• Osteopenia | 44.7 | 54.3 | 46.2 | 45.5 | 47.5 | 46.6 | ||
• Osteoporosis | 31.6 | 40.7 | 27.2 | 39.0 | 22.2 | 32.2 | ||
CRF (%) | ||||||||
Previous fracture ≥ 50 years | 25.9 | 12.6 | 21.4 | 16.4 | 23.9 | 20.9 | 2.1 | <0.001 |
Previous vertebral fracture | 6.8 | 9.6 | 6.0 | 5.8 | 9.3 | 7.0 | 1.7 | <0.001 |
Family history of hip fracture | 15.4 | 7.3 | 8.9 | 18.6 | 26.9 | 15.6 | 3.7 | <0.001 |
Immobility | 3.0 | 0.7 | 0.4 | 0.9 | 10.7 | 2.9 | 26.8 | <0.001 |
Low body weight (<60 kg) | 19.0 | 17.0 | 13.1 | 13.8 | 8.6 | 14.4 | 2.2 | <0.001 |
Use of corticosteroids | 0.7 | 7.4 | 0.2 | 1.6 | 5.0 | 2.2 | 37.0 | <0.001 |
Fall risk (%) | ||||||||
Fall in preceding 12 months | 20.5 | 21.8 | 3.7 | 14.4 | No datac
| 14.1 | 5.9 | <0.001 |
Fracture due to fall from standing height | 80.6 | 91.1 | 81.5 | 81.3 | 51.0 | 77.2 | 1.8 | <0.001 |
Prevalence aetiology of the fracture (%) | ||||||||
Accident at home | 28.2 | 58.4 | 31.5 | 34.9 | 42.8 | 34.7 | 2.1 | <0.001 |
Accident at work | 1.6 | 0.2 | 1.4 | 2.0 | 2.6 | 1.7 | 10.0 | 0.021 |
Fall accident | 80.6 | 91.1 | 81.5 | 81.3 | 51.0 | 77.2 | 5.9 | <0.001 |
Traffic accident | 11.0 | 23.3 | 14.4 | 26.9 | 7.7 | 16.0 | 3.5 | <0.001 |
Sport accident | 4.0 | 3.0 | 5.7 | 7.1 | 4.5 | 5.1 | 2.4 | <0.001 |
Aetiology unknown | 4.7 | 8.0 | 3.8 | 2.1 | 1.6 | 3.6 | 5.0 | <0.001 |
Aetiology other | 6.8 | 0.5 | 17.5 | 6.6 | 2.8 | 7.9 | 35.0 | <0.001 |
Patient characteristics
Women | Men | All | P value | |
---|---|---|---|---|
Fracture sites (%) | <0.001 | |||
• Major | 15.6 | 15.6 | 15.6 | |
• Minor | 71.6 | 65.1 | 70.1 | |
• Hip | 5.3 | 7.0 | 5.7 | |
• Fingers/Toes | 7.6 | 12.3 | 8.7 | |
<0.001 | ||||
• Hip | 5.3 | 7.0 | 5.7 | |
• Humerus | 13.1 | 9.3 | 12.2 | |
• Distal radius/ulna | 29.5 | 15.0 | 26.1 | |
• Tibia/fibula | 12.2 | 15.1 | 12.9 | |
• Other | 40.0 | 53.6 | 43.2 |