Referral to a specialised fracture liaison service following a minimal trauma fracture reduces the risk of further major fractures by more than 40%, a study at John Hunter Hospital in Newcastle has shown.

Dr Ayano Nakayama and colleagues compared outcomes of patients referred from the emergency department to the hospital’s fracture liaison service (FLS) with those from a similar major hospital which also had trauma, endocrinology, rheumatology and aged care units but no FLS.

They used local health district electronic records to identify subsequent fractures during the next three years in a total of 931 patients.

“There were 12% of patients at the John Hunter Hospital and 17% at the non-FLS hospital who had another minimal trauma fracture,” Dr Nakayama said.

“After accounting for their baseline characteristics, this amounted to a 33% reduction in the rate of any re-fracture at the FLS hospital.

“The absolute risk reduction of 5% translates to a number needed to treat of 20 to prevent one fracture over three years.”

Analysis of the subset of patients with a major re-fracture (hip, spine, femur, pelvis or humerus) identified a significant 41% reduction in the FLS hospital, and there was also a trend to fewer non-major fractures.

“We know that 80-90% of minimal trauma fractures remain uninvestigated and untreated,” Dr Nakayama said.

“Fracture liaison services have been promoted as the most effective interventions for secondary fracture prevention and have been shown to increase the rate of investigation and treatment, but only a few studies have considered fracture outcomes directly.”

Limitations of the study included its retrospective nature, a reliance on data from hospitals only within the local health district to identify further fractures, and a lack of information on the treatment actually provided.

“Unfortunately it’s very difficult to do a randomised controlled study for this sort of intervention, so we usually have to rely on historical data,” she said.