Fracture Liaison Services (FLS), that provide assessment, treatment and follow up to fracture patients using a multidisciplinary approach, have been shown to improve the care for fragility fracture patients in Malaysia and should be consolidated and expanded to provide care to individuals throughout the country. 

Fragility fractures, often resulting from low-impact injuries, become increasingly common as we age. These fractures can double the risk of experiencing another fracture in one's lifetime, with the highest risk occurring within 18 months of the initial fracture. Unfortunately, many patients do not receive proper risk assessments and interventions to reduce this risk. This is where the Fracture Liaison Service (FLS) steps in to bridge the gap in treatment. 

In Malaysia, a scoping review by Lim et al delved into the role of FLS services in Malaysia. FLS services are multidisciplinary in nature, involving various departments such as orthopedics, osteoporosis expertise, bone densitometry, rehabilitation, falls services, and primary care. These services are coordinated to provide comprehensive care for patients, including assessment, treatment, and follow-up. The review explored the current state of FLS services in Malaysia, noting that while there are 12 FLS services primarily located in the Klang Valley (an urban sector of Malaysia), coverage remains limited, and many Malaysians lack access to these services. 

The study also discussed the organization and delivery of FLS services, including team composition and patient eligibility criteria. Furthermore, it highlighted the impact of FLS, with one public hospital reporting increased BMD assessments (by about 2 to 3 folds) and medication adherence. It also emphasized the consensus among local experts and national guidelines supporting the expansion of FLS services and the need for a multidisciplinary approach. For instance, the Fragility Fracture Network Malaysia was established to improve the care for people with fragility fractures by prioritizing secondary fragility fracture prevention and promoting the role of the FLS. 

The study called for the consolidation of existing FLS services and the development of new ones to address the secondary fracture prevention gap in Malaysia. It stresses the importance of public awareness, research, and advocacy by specialist societies to make FLS a part of national policy and improve fracture prevention efforts. And finally, as stated in the study, “FLS services will be the key to address the secondary fracture prevention gap in Malaysia.”

Read the article here!

Older adults living with Alzheimer’s disease or related dementias (ADRD) have higher incidence and worse outcomes after a hip fracture. Days Spent at Home before the hip fracture episode could be taken into consideration at surgical decision making and discharge planning.

This study undertaken in USA explored the association between days at home (DAH) before a hip fracture and post-fracture outcomes, including 1-year mortality, in 16576 community-dwelling older adults living with ADRD.

Days at Home were calculated based on the number of days that each patient was alive and not in hospitals, skilled nursing facilities, days in hospital observation or emergency department during the study period (6 months prior to and 12 months post hip fracture).

A fundamental result of this study was that pre-fracture DAH offered valuable prognostic information about post-fracture recovery of this vulnerable population, as patients in more unfavorable pre-fracture condition with a lower number of DAH had:

• 65% higher risk for mortality at 1 year than those who spent the majority of their pre-fracture days at home and
• more than double probability of spending more days of the post-fracture period hospitalized or in institutional care settings.

Furthermore, higher number of DAH was significantly associated with full post-fracture recovery. This finding is of major importance, according to the authors of this study, due to the fact that it helps ‘raise recovery expectations’ and ‘undercut common misconceptions contributing to underutilization of aggressive rehabilitation care’ in these patients.

DAH can be used as an objective measure to report preoperative health of older adults with ADRD and contribute at the optimal decision making either for surgery, discharge or post-discharge care.

Read the article here!

Assessing for fracture risk in older patients who have undergone total hip and knee arthroplasties can be successfully completed using FRAX.

Postoperative periprosthetic fractures (PPF) are severe complications of total hip or knee arthroplasties (THA/TKA) and are associated with an important burden for patients as well as high costs for the health care system.

A study conducted in Austria evaluated the value of FRAX to estimate the risk of postoperative periprosthetic fractures in 167 patients following total hip and knee arthroplasty. For all patients, the 10-year probability of a major osteoporotic fracture and an osteoporotic hip fracture was calculated using FRAX.

The results of the study showed that the majority of patients with a postoperative periprosthetic fracture had an increased risk (10-year probability) of major osteoporotic fracture and hip fracture according to FRAX. Despite this high risk though, less than 10% of the patients received adequate anti-osteoporotic treatment.

Moreover, a significant correlation was found between the 10-year probability of a major osteoporotic fracture and hip fracture and postoperative periprosthetic fractures in THA and TKA, indicating that FRAX might be a useful tool in calculating fracture risk in these patients. The risk of PPF was also higher in older patients and patients who had sustained a previous fracture.

The study highlights, among other findings, the serious undertreatment of patients with PPF in respect to osteoporosis, an issue of major importance that must be managed by a multidisciplinary team.

Read the study here!

Early surgery is essential following a hip fracture as it improves the outcomes for patients and it results in lower rates of mortality, length of hospital stay and postoperative complications, thereby reducing the burden on the healthcare system.

This study undertaken in China explored the association between the surgical timing and the prognoses in 701 elderly patients with hip fracture, dividing them in the early surgery group (surgery within 2 days of admission) and the delayed surgery group (surgery after 2 days of admission). The two groups were compared in terms of perioperative parameters, complications within 30 days after surgery, prognostic indicators and complications six months after surgery.

The results of the study showed that:

• There was a significantly reduced postoperative hospital stay and incidence of complications (pulmonary infections, UTIs and DVT) within 30 days after surgery in the early surgery group compared to the delayed surgery group. 
• At six months after surgery, although early surgery had no significant effect on patient mortality compared with delayed surgery, early surgery significantly reduced patient rehospitalisation rates.
• There was no significant difference in the Harris Hip Scores between the two groups, indicating that surgical timing does not influence the short-term recovery of hip joint function after surgery. Quality of life in the delayed surgery group was significantly lower than that in the early surgery group at 30 days and 6 months after operation. 

These results reflect the findings in other regions of the world and further confirm the growing body of literature that early surgery, within 48 hours, is recommended for patients after a hip fracture improving outcomes for patients and reducing the burden on the system.

Read the study here.