Osteoporosis International

, Volume 30, Issue 9, pp 1779–1788 | Cite as

Secondary prevention of osteoporotic fractures: evaluation of the Lille University Hospital’s Fracture Liaison Service between January 2016 and January 2018

  • A. Pflimlin
  • A. Gournay
  • I. Delabrière
  • C. Chantelot
  • F. Puisieux
  • B. Cortet
  • J. PaccouEmail author
Original Article



The purpose of this study was to assess the performance of our Fracture Liaison Service (FLS) over a period of 2 years. Osteoporosis medication was prescribed for 243 patients, and zoledronic acid was the main drug prescribed (60.2%).


A Fracture Liaison Service (FLS) was implemented at Lille University Hospital in 2016. The main purpose of this study was to assess the performance of the FLS using criteria proposed by the International Osteoporosis Foundation (IOF).


The criteria used were patient identification, patient evaluation, post-fracture assessment timing, vertebral-fracture identification, blood and bone mineral density (BMD) testing, falls prevention, multifaceted health and lifestyle risk-factor assessment, and medication initiation and review.


Between January 2016 and January 2018, 736 patients (≥ 50 years old) with a recent history of fragility fracture (≤ 12 months) were identified. The identification rate for hip fractures was 74.2%. However, patient evaluation for all type of fractures was quite low (30.3%) since many patients failed to attend the FLS unit. The reasons for non-attendance were refusal, agreed but subsequently failed to attend, and still waiting to be seen. In all, 256 patients (76.6% female, mean (SD) age 74.3 (11.0) years) were seen at the FLS. Mean (SD) post-fracture assessment timing was 13.3 (9.3) weeks. Of the 139 patients seen for a non-vertebral fracture, 103 were assessed for vertebral fractures, and at least one new vertebral fracture was found in 45 of them (43.7%). Osteoporosis medication was prescribed for 243 (94.9%) patients. The main osteoporosis drug prescribed was zoledronic acid (60.2%).


Secondary prevention of osteoporotic fractures has improved since the implementation of the FLS. However, patient identification, patient evaluation, and post-fracture assessment timing still need to be improved.


Fracture Fracture liaison service Hip fracture Osteoporosis Vertebral fracture 


Compliance with ethical standards

Conflicts of interest

Julien Paccou has received honoraria from Amgen, MSD, Eli Lilly and Pfizer. Bernard Cortet has received honoraria from Amgen, Eli Lilly, Expanscience, Ferring, Medtronic, Novartis, and Roche Diagnostics. For the remaining authors, none were declared.


  1. 1.
    NIH Consensus Development Panel on (2001) Osteoporosis prevention, diagnosis, and therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795CrossRefGoogle Scholar
  2. 2.
    Melton LJ, Chrischilles EA, Cooper C, Lane AW, Riggs BL (2005) How many women have osteoporosis? J Bone Miner Res 20:886–892CrossRefGoogle Scholar
  3. 3.
    Briot K, Maravic M, Roux C (2015) Changes in number and incidence of hip fractures over 12 years in France. Bone 81:131–137CrossRefGoogle Scholar
  4. 4.
    van Geel TM, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:99–102CrossRefGoogle Scholar
  5. 5.
    Bliuc D, Center JR (2016) Determinants of mortality risk following osteoporotic fractures. Curr Opin Rheumatol 28:413–419CrossRefGoogle Scholar
  6. 6.
    Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39:1157–1163CrossRefGoogle Scholar
  7. 7.
    Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J et al (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137CrossRefGoogle Scholar
  8. 8.
    Eastell R, Black DM, Boonen S, Adami S, Felsenberg D, Lippuner K, Cummings SR, Delmas PD, Palermo L, Mesenbrink P, Cauley JA, for the HORIZON Pivotal Fracture Trial (2009) Effect of once-yearly Zoledronic acid five milligrams on fracture risk and change in femoral neck bone mineral density. J Clin Endocrinol Metab 94:3215–3225CrossRefGoogle Scholar
  9. 9.
    Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mellström D, Oefjord ES, Marcinowska-Suchowierska E, Salmi J, Mulder H, Halse J, Sawicki AZ, Mitlak BH (2001) Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441CrossRefGoogle Scholar
  10. 10.
    Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C, FREEDOM Trial (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765CrossRefGoogle Scholar
  11. 11.
    Thomas T, Gabach P, Buchon D et al Évaluation de la prise en charge avant et après hospitalisation pour fracture de fragilité en France à partir des dossiers de la SNIIRAM. Congrès SFR 2015, communication O.116Google Scholar
  12. 12.
    Nakayama A, Major G, Holliday E, Attia J, Bogduk N (2016) Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate. Osteoporos Int 27:873–879CrossRefGoogle Scholar
  13. 13.
    Huntjens KM, van Geel TA, van den Bergh JP, van Helden S, Willems P, Winkens B et al (2014) Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am 96:e29CrossRefGoogle Scholar
  14. 14.
    McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L et al (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22:2083–2098CrossRefGoogle Scholar
  15. 15.
    Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD et al (2013) IOF fracture working group. Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152CrossRefGoogle Scholar
  16. 16.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporosis Int 19:385–397CrossRefGoogle Scholar
  17. 17.
    World Health Organization (WHO) (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group. WHO Technical Report Series n°843. WHO, Genève, pp 1–29Google Scholar
  18. 18.
    Briot K, Roux C, Thomas T, Blain H, Buchon D, Chapurlat R, Debiais F, Feron JM, Gauvain JB, Guggenbuhl P, Legrand E, Lehr-Drylewicz AM, Lespessailles E, Tremollieres F, Weryha G, Cortet B (2018) 2018 update of French recommendations on the management of postmenopausal osteoporosis. Joint Bone Spine 85:519–530CrossRefGoogle Scholar
  19. 19.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  20. 20.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 301:513–521CrossRefGoogle Scholar
  21. 21.
    Royal College of Physicians (2017) Fracture liaison service database (FLS-DB) annual report. Leading FLS improvement: secondary fracture prevention in the NHS. RCP, LondonGoogle Scholar
  22. 22.
    Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH et al (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF capture the fracture® best practice framework tool. Osteoporos Int 26:2573–2578CrossRefGoogle Scholar
  23. 23.
    Dehamchia-Rehailia N, Ursu D, Henry-Desailly I, Fardellone P, Paccou J (2014) Secondary prevention of osteoporotic fractures: evaluation of the Amiens University Hospital’s fracture liaison service between January 2010 and December 2011. Osteoporos Int 25:2409–2416CrossRefGoogle Scholar
  24. 24.
    Campbell AJ, Reinken J, Allan BC, Martinez GS (1981) Falls in old age: a study of frequency and related clinical factors. Age Ageing 10:264–270CrossRefGoogle Scholar
  25. 25.
    Edwards BJ, Bunta AD, Simonelli C, Bolander M, Fitzpatrick LA (2007) Prior fractures are common in patients with subsequent hip fractures. Clin Orthop Relat Res 461:226–230Google Scholar
  26. 26.
    Amouzougan A, Deygat A, Trombert B, Constant E, Denarié D, Marotte H, Thomas T (2015) Spectacular improvement in vitamin D status in elderly osteoporotic women: 8-year analysis of an osteoporotic population treated in a dedicated fracture liaison service. Osteoporos Int 26:2869–2875CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of RheumatologyLille University HospitalLilleFrance
  2. 2.Department of GerontologyLille University HospitalLilleFrance
  3. 3.Department of TraumatologyLille University HospitalLilleFrance
  4. 4.PMOILille University–ULCOLilleFrance

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