Abstract
Introduction: Fragility fractures increases re-fracture and mortality risk, especially within two years. Fracture Liaison Services (FLS) aim to prevent secondary fractures by ensuring quality care for patients over 50. This study assesses equity of care in an existing FLS for patients above and below 80 years and evaluates re-fracture and mortality outcomes.
Methods: We retrospectively reviewed 2,190 patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) from January-December 2023 using national FLS Database (FLS-DB) data. After excluding 14 patients with missing data, 2,176 were categorized as: below 80 and above 80 years. Data on previous fractures, re-fractures, and fracture type (hip/femur, spine, wrist, humerus, pelvis, others) were collected. Patients were followed until March 31, 2025, for re-fractures and mortality.
Results: The cohort's mean age was 78.6 years (range: 50–103), with a significant female predominance (76.9%, p<0.0001). Prior fractures were recorded in 50.7% (n=1104), with a mean interval of 6 years (range: 0–36). Most (93.3%) lived in the community, 6.7% were in care homes.
AB-FLS reviewed 1103 (50.7%) patients aged 50–80 and 1073 (49.3%) aged over 80, with no significant group differences. Female distribution was similar (78.8% vs.75%). Bone treatment was initiated in 1207 (55.2%) patients.
Over 27 months follow-up, 1801 (82.8%) had no re-fracture.
Overall, 17.2% (n=374) re-fractured (mean time: 253 days, range: 2–767 days). A significantly higher patients re-fractured in over 80 years (n= 209, 55.9%, mean 235 days) as compared to under 80 years (n=165, 44.1%, mean 276 days, p=0.023).
At 12 months, 264 (12.1%) re-fractured: 154 (58.3%) over 80 (mean 137 days) and 110 (41.7%) under 80 (mean 151 days, p=0.008).
By 27 months, 503 patients had died. One-year mortality was 18.6% (n=387), significantly higher in those over 80s (75.7%, n=293) than under 80 (24.3%, n=94, p<0.0001).
Conclusion: The AB-FLS has demonstrated equitable care over the consecutive twelve-month period; however, further assessment over a longer timeframe is needed for confirmation. Given the significantly higher risk of re-fracture and mortality in older patients, secondary fracture services should be tailored to better address the needs of this population, ensuring true equity in healthcare.
Comments
Thank you for this…
Thank you for this interesting poster. It's good to see that care provided is equitable although, as perhaps expected, outcomes are worse in the older group. It would be interesting to see if future research the reasons why those older than 80 have greater refracture rates despite receiving equitable care (e.g. do they have more falls, or have lower BMD on average?).
The age range is very wide here so I was wondering if you did any further analysis of your data based on more narrow age ranges? For example, the refracture risk and mortality risk of those 50-65 years old, who depending on service set up may not have orthogeriatric input.
very interesting poster
Great project, interesting to see the results from referring to FLS. How do these findings compare to national FLS outcomes in similar populations, do you know if the re-fracture or mortality rate is higher, lower, similar?
Great project and good work…
Great project and good work.
This is a highly important and timely area of research. Ensuring equitable access to secondary fracture prevention for adults aged 80 years and older is essential, as this group often faces multiple barriers such as comorbidities, mobility issues, and limited healthcare access. Your focus on equity emphasizes that age should never be a limiting factor in receiving optimal osteoporosis care. Strengthening pathways for early identification, treatment, and follow-up in this population can significantly reduce fracture recurrence and improve quality of life.
Your poster delivers a…
Your poster delivers a powerful message about ensuring fair access to secondary fracture prevention for adults over 80. It clearly highlights the need for equitable care, timely support, and improved outcomes for older adults
Good input
This assessment is highly appreciated for prevention of fractures in geriatric age group. Great work