# Osteoporosis treatment indications following fracture: identifying relevant fracture sites for Fracture Liaison Services

## TL;DR

This study shows that including all fracture patients, not just those with major fractures, in Fracture Liaison Services leads to high rates of osteoporosis treatment.

## Contribution

The study demonstrates that non-major osteoporotic fractures also warrant inclusion in FLS for effective secondary prevention.

## Key findings

- High treatment indication rates were observed in both non-MOF (51%) and MOF (71%) patients.
- Low numbers needed to screen (NNS) were found for both non-MOF (1.95) and MOF (1.41) groups.
- BMD and risk profiles were similar between non-MOF and MOF patients with treatment indication.

## Abstract

Osteoporotic fractures are associated with morbidity, mortality and high healthcare costs. Fracture Liaison Services (FLS) prevent subsequent osteoporotic fractures but are traditionally limited to include major osteoporotic fractures (MOF). When the FLS at Skaraborg Hospital in Skövde, Sweden included both MOF and non-MOF, treatment indication was present for 51% (Number Needed to Screen (NNS) 1.41) and 71% (NNS 1.95), respectively. High treatment indication rates and low NNS were observed both in patients with MOF and non-MOF, suggesting that all fracture patients should be included in FLSs.

Fracture Liaison Services (FLS) are coordinator-based, multidisciplinary programmes that provide systematic secondary prevention of fragility fractures. Many FLS programmes have been limited to major osteoporotic fractures (MOF, i.e. vertebrae, hip, proximal humerus, wrist and pelvis), but it is unclear whether patients with other types of fractures have similar risk profiles, as defined by low bone mineral density (BMD) and present clinical risk factors (CRF).

To compare key characteristics related to fracture risk (e.g. FRAX and BMD) and eligibility for osteoporosis treatment between patients with a recent non-MOF and those with recent MOF after inclusion in an FLS at Skaraborg Hospital in Skövde, Sweden.

Patients 50 years and older with a BMD measurement between December 2023 and May 2024, with a recent fracture were included (N = 705). Data on age, sex, CRFs, FRAX score, BMD, trabecular bone score, vertebral fracture assessment (VFA), and physician-issued assessment of osteoporosis treatment indication from the FLS evaluation were collected. Differences were analyzed using t-tests, chi-square tests, and expressed as standardized mean differences. The odds ratio (OR) for osteoporosis treatment indication (yes/no) was calculated using logistic regression for non-MOF vs. MOF, with adjustment for incremental number of confounders.

There were high rates of osteoporosis treatment indication in both non-MOF (51%) and MOF (71%) patients, and low numbers needed to screen (NNS) to identify one patient with osteoporosis treatment indication in both the non-MOF (1.95) and MOF groups (1.41). When comparing non-MOF and MOF within the subgroup of patients with osteoporosis treatment indication, BMD and risk profiles were similar.

The proportions of patients with osteoporosis treatment indications were high regardless of fracture site category, indicating that patients with both recent non-MOF and MOF should be included in FLS programmes.

The online version contains supplementary material available at 10.1007/s11657-026-01690-0.