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Challenges and opportunities to improve fracture liaison service attendance: fracture registration and patient characteristics and motivations

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Abstract

Summary

This questionnaire-based study evaluated the reasons for attendance or non-attendance at the fracture liaison service in patients with a recent fracture. Frailty, male sex, living alone, and low education were associated with non-attendance, and the information perceived by the patient was associated with attendance.

Introduction

The purpose of this study was to evaluate hospital registration- and patient-related factors associated with attendance or non-attendance to the Fracture Liaison Service (FLS).

Methods

Out of 1728 consecutive patients registered with a recent fracture at hospital entry, and after exclusion of 440 patients because of death, residence in a nursing home, already on osteoporosis treatment, or recent DXA, 1288 received an FLS invitation. We evaluated the hospital registration of fractures at entry and exit of the hospital. A questionnaire was sent to all invited patients to evaluate factors related to non-attendance (including age, gender, frailty, living alone, income, education, extrinsic motivations (impact of perceived information) and intrinsic motivations (patient’s own perceived views and opinions) and to attendance (personal impact of clinical professionals’ advice).

Results

There were 278 more hospital exit codes than entry codes. Of the 1288 invited patients, 745 returned analyzable questionnaires (537 attenders and 208 non-attenders). Non-attendance was associated with male gender (OR: 2.08, 95% CI: 1.35, 3.21), frailty (OR: 1.62, CI: 1.08, 2.45), living alone (OR:2.05, CI: 1.48, 2.85), low education (OR: 1.82, CI: 1.27, 2.63), not interested in bone strength (OR: 1.85, CI: 1.33, 2.63), and being unaware of increased subsequent fracture risk (OR: 1.75, CI: 1.08, 2.86). Information perceived by the patient was significantly associated with attendance (OR: 3.32, CI: 1.75, 6.27).

Conclusion

Fracture entry registration inaccuracies, male gender, frailty, living alone, having low general education, or low interest in bone health and subsequent fracture risk were independently associated with FLS non-attendance. Adequately perceived advice (to have a bone densitometry and attend the FLS) was strongly associated with FLS attendance.

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Acknowledgments

We are grateful to Mrs. Wil Aarssen and Mrs. Maria van Woerden for their excellent secretarial services and to Mrs. Lisette van Hulst for her linguistic advice.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumasurgery, Fracture Liaison Service, Reinier de Graaf Hospital, Delft, The Netherlands

    P. van den Berg

  2. Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Hospital, Delft, The Netherlands

    P.M.M. van Haard

  3. Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands

    P.P. Geusens

  4. Hasselt University, Hasselt, Belgium

    P.P. Geusens

  5. Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg and Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands

    J.P. van den Bergh

  6. Department of Internal Medicine and Endocrinology, Reinier the Graaf Hospital, Delft, The Netherlands

    D.H. Schweitzer

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Contributions

PVDB, DHS, and PVH are responsible for the study design. PVDB and DHS were the authors, supported by PVH, who also performed all statistical analyses. PG and JVDB supported the process with important scientific contributions.

Corresponding author

Correspondence to P. van den Berg.

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Ethics

The study was carried out in accordance with the declaration of Helsinki and the guidelines of the International Conference on Harmonization Good Clinical Practice (GCP) after a certificate of no objection approved by the regional Medical Ethical Review Board (METC Zuidwest Holland) no. NL 17.109.

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van den Berg, P., van Haard, P., Geusens, P. et al. Challenges and opportunities to improve fracture liaison service attendance: fracture registration and patient characteristics and motivations. Osteoporos Int 30, 1597–1606 (2019). https://doi.org/10.1007/s00198-019-05016-4

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