The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly

Several guidelines recommend a bone and fall-related osteoporosis risk assessment in all patients with fracture and age 50 years. In practice, however, there is no consensus whether screening 85 years is useful.To evaluate the subsequent fracture risk in all patient 85 years, comparing the two populations of Fracture Liaison Service (FLS) attenders and non-attenders.All patients 85 years that presented at the FLS with a non-vertebral fracture were included in the study during a 5-year period (September 2004 and December 2009). Excluded were pathologic fractures, death 30 days, or patients on osteoporosis treatment. in patients that attended the FLS, assessment of bone mineral density and fall-risk factors were screened. In both the attenders and non-attenders groups, mortality and subsequent fracture rates were scored during a follow-up of 2 years.282 patients fulfilled inclusion criteria for screening, of which 160 (57%) patients did not attend the FLS. 122 patients were screened for osteoporosis and fall-related risk of whom 72 were diagnosed with osteoporosis. Subsequent fracture risk in both groups was 19%. Medical treatment was started in 51 patients, of which 15 patients developed a subsequent fracture. Cox-regression analysis indicated a significantly lower mortality rate, but not a diminished subsequent fracture rate in the FLS screened population compared to the non-attenders.The advantage of a FLS in reducing subsequent fracture risk in patients 85 years seems to be limited. In practice a large proportion of these patients are not screened.