The impact of a Fracture Liaison Service after 3 years on secondary fracture prevention and mortality in a Portuguese tertiary center.

Despite the establishment of Fracture Liaison Services (FLS) worldwide, no study has evaluated their impact on the Portuguese population. Our work has shown that the implementation of an FLS is associated with a significant increase in OP treatment and a lower risk of secondary fracture. PURPOSE: Fracture Liaison Services (FLS) have been established worldwide, with positive effects on treatment, secondary fracture, mortality, and economic burden. However, no study has evaluated their impact on the Portuguese population. Therefore, we purposed to evaluate the effect of an FLS model in a Portuguese center on osteoporosis (OP) treatment, secondary fracture, and mortality rates, 3 years after a fragility fracture. METHODS: Patients over 50 years old, admitted with a fragility fracture, between January 2017 and December 2020, were included in this retrospective study. Patients evaluated after FLS implementation (2019-2020) were compared with those evaluated before (2017-2018) and followed for 36 months. Predictors of secondary fracture and mortality were assessed using a multivariate Cox regression model, adjusted to potential confounders. RESULTS: A total of 551 patients were included (346 before and 205 after FLS). The FLS significantly increased the rate of OP treatment, when compared with standard clinical practice (8.1% vs 77.6%). During follow-up, the secondary fracture rate was 14.7% and 7.3%, before and after FLS, respectively. FLS was associated with a lower risk of secondary fracture (HR 0.39, C.I. 0.16-0.92). Although we observed a lower mortality rate (25.1% vs 13.7%), FLS was not a significant predictor of survival. CONCLUSION: Implementing the FLS model in a Portuguese center has increased OP treatment and reduced the risk of secondary fracture. We believe that our work supports adopting FLS models in national programs.

What happened to hip fragility fractures during COVID-19 pandemic?

PURPOSE: COVID-19 changed the dynamics of all healthcare system, leading to the restructuring of inpatient teams as well as the emergency department. Scheduled surgeries were suspended, operating rooms were closed, and anesthesiologists redistributed among the various intensive care units. At the Centro Hospitalar do Baixo Vouga the number of patients admitted to the emergency department decreased to approximately 8.000 during the period of lockdown which ranged from 18th March to 1st June 2020. The aim of this study was to compare the number of patients presenting with hip fractures during the first wave of the COVID-19 pandemic with the equivalent period in 2019 and to analyze postoperative outcomes. METHODS: An observational retrospective study was conducted in two different periods. Patients over the age of 50 years admitted with hip fracture were included for analysis. The data was collected from the hospital database. A general descriptive analysis was performed. RESULTS: There was an overall reduction in the number of admissions due to hip fractures in Period 2020 compared with homologous Period in 2019 (68 patients and 94 patients, respectively). No statistically significant differences could be found regarding age, gender, ASA grade and pre-admission residence among patients admitted during these both periods. Nursing home patients in Period 2020 had a longer hospital stay (p=0.03), independently of the functional status (p=0.07). There were no statistically significant differences in the time it took the patient to go to the emergency department after the fall, place where the fracture had occurred, waiting time to perform the surgery, type of treatment performed, post-surgical complications and mortality. There was no relationship between mortality and the time it took the patient to access the emergency department (p=0,487), or mortality and the mean length of stay in the hospital (p=0,151). All the patients admitted to the emergency department in Period 2020 were negative to PCR test for SARS-CoV-2. CONCLUSION: The measures taken by the hospital during the pandemic had no impact in the healthcare provided to the admitted patients. This should be taken into account in order to optimize the efficiency of the health care system in future outbreaks.