Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study

Age Ageing. 2016 Mar;45(2):236-42. doi: 10.1093/ageing/afv204. Epub 2016 Jan 21.


Objectives: to evaluate orthogeriatric and nurse-led fracture liaison service (FLS) models of post-hip fracture care in terms of impact on mortality (30 days and 1 year) and second hip fracture (2 years).

Setting: Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England.

Population: patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013.

Methods: each hospital was analysed separately and acted as its own control in a before-after time-series design in which the appointment of an orthogeriatrician or set-up/expansion of an FLS was evaluated. Multivariable Cox regression (mortality) and competing risk survival models (second hip fracture) were used. Fixed effects meta-analysis was used to pool estimates of impact for interventions of the same type.

Results: of 33,152 primary hip fracture patients, 1,288 sustained a second hip fracture within 2 years (age and sex standardised proportion of 4.2%). 3,033 primary hip fracture patients died within 30 days and 9,662 died within 1 year (age and sex standardised proportion of 9.5% and 29.8%, respectively). The estimated impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) = 0.73 (95% CI: 0.65-0.82) and HR = 0.81 (CI: 0.75-0.87), respectively. Following an FLS, these associations were as follows: HR = 0.80 (95% CI: 0.71-0.91) and HR = 0.84 (0.77-0.93). There was no significant impact on time to second hip fracture.

Conclusions: the introduction and/or expansion of orthogeriatric and FLS models of post-hip fracture care has a beneficial effect on subsequent mortality. No evidence for a reduction in second hip fracture rate was found.

Keywords: epidemiology; fracture liaison service; hip fracture; older people; orthogeriatrician; osteoporosis.

Publication types

  • Evaluation Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Delivery of Health Care, Integrated / organization & administration*
  • Female
  • Geriatrics / organization & administration*
  • Health Services Research
  • Health Services for the Aged / organization & administration*
  • Hip Fractures / diagnosis
  • Hip Fractures / mortality
  • Hip Fractures / therapy*
  • Hospitalization
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Orthopedics / organization & administration*
  • Patient Care Team / organization & administration
  • Process Assessment, Health Care*
  • Program Evaluation
  • Proportional Hazards Models
  • Recurrence
  • Risk Factors
  • Time Factors
  • Treatment Outcome