Assessment of clinical characteristics of patients included in the fracture liaison service and patient-level key performance indicators

Aim: To examine the clinical characteristics of patients included in the Fracture Liaison Service (FLS) and evaluate the performance of the FLS using key performance indicators (KPIs) recommended by the International Osteoporosis Foundation for quality assessment. Material and Methods: The study retrospectively included 160 patients aged 50 years and older with osteoporotic fractures admitted to our FLS centre between 2019 and 2023. KPI 1 is identification of the non-vertebral patient and KPI 2 is for the vertebral patient, KPI 3 is investigation within 12 weeks, KPI 4 is DXA testing within 12 weeks, KPI 5 is fall risk assessment, KPI 6 is recommendation of antiosteoporotic medication, KPI 7 is follow-up within 16 weeks, KPI 8 is initiation of medication within 16 weeks, KPI 9 is initiation of strength and balance exercises, KPI 10 is follow-up after 52 weeks, KPI 11 is ensuring data integrity. The success of KPIs and factors that may affect the success were investigated. Clinical history and demographic data of the cases, vertebral fracture level, non-vertebral fracture area, FRAX scores, DXA measurements, laboratory values, Timed up-and-go test (TUG), and treatment preference were evaluated. The endpoint was taken as the 16th week. Results: The success of KPI 1 was 4%, KPI 2 was 30%, KPI 3 was 100%, KPI 4 was 63%, KPI 5 was 74%, KPI 6 was 95%, KPI 7 and 8 were 65%.KPI 1, 2 are prioritised to be improved, KPI 4, 5, 7, 8 need to be improved, KPI 3 and 6 are identified as areas with adequate service quality. Conclusion: Secondary prevention of osteoporotic fractures has advanced with the introduction of FLS. However, interdisciplinary coordination should be improved for the detection and follow-up of patients, and FLSs should be supported by national and regional healthcare systems.