Adherence to secondary fracture prevention is associated with reduced risk of subsequent fractures

Åshild Bjørnerem; Jashar Khoshkhabari; Ann Kristin Hansen; Tove Tveitan Borgen; Frede Frihagen; Lene Bergendal Solberg; Tone Kristin Omsland; Frida Igland Nissen

doi:10.1007/s00198-025-07697-6

Adherence to secondary fracture prevention is associated with reduced risk of subsequent fractures

Osteoporos Int. 2025 Nov;36(11):2263-2272. doi: 10.1007/s00198-025-07697-6. Epub 2025 Sep 24.

Authors

Åshild Bjørnerem^{1

2

3}, Jashar Khoshkhabari⁴, Ann Kristin Hansen^{4

5}, Tove Tveitan Borgen⁶, Frede Frihagen^{7

8}, Lene Bergendal Solberg⁹, Tone Kristin Omsland¹⁰, Frida Igland Nissen^{4

11

5}

Affiliations

¹ Department of Clinical Medicine, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway. ashild.bjornerem@uit.no.
² Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway. ashild.bjornerem@uit.no.
³ Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway. ashild.bjornerem@uit.no.
⁴ Department of Clinical Medicine, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway.
⁵ Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway.
⁶ Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.
⁷ Department of Orthopaedic Surgery, Østfold Hospital Trust, N-1712, Grålum, Norway.
⁸ Institute of Clinical Medicine, University of Oslo, N-0407, Oslo, Norway.
⁹ Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
¹⁰ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
¹¹ Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.

Abstract

Attenders to fracture liaison services in a quality assessment study of 1936 women and men ≥ 50 years had 20% lower risk of subsequent fractures and 33% lower mortality than non-attenders. Patient's who were adherent to AOD after 12 months had a 49% lower risk of fractures than non-adherent patients.

Purpose: Secondary fracture prevention rates are low in Norway and internationally. To overcome the existing treatment gap, fracture liaison services (FLS) are recommended. The study aimed to assess impact of FLS on fracture rates and mortality among attenders versus non-attenders, and patients adherent versus non-adherent to AOD.

Methods: This single-center sub-study of the Norwegian Capture the Fracture Initiative included 1936 women and men ≥ 50 years of age with an index fracture of any type during 2015-2018. We estimated hazard ratios (HR) for subsequent fractures and mortality in 1041 attenders versus 895 non-attenders to the FLS, and 427 patients who were adherent versus 174 patients who were non-adherent to anti-osteoporotic drugs (AOD) 12 months after treatment initiation.

Results: During a median 3.5-years observation (range 0.5 to 6.3), attenders had a 20% lower risk of subsequent fractures of any type (HR 0.80; 95% CI 0.64-0.999) and 33% lower mortality (HR 0.67; 95% CI 0.51-0.89) than non-attenders. Patients who were adherent to AOD after 12 months had a 49% lower risk of subsequent fractures than non-adherent patients (HR 0.51; 95% CI 0.35-0.72), but no difference in mortality was shown. Models were adjusted for age, sex, body mass index, smoking, prior fracture, and index hip fracture.

Conclusion: These results confirm that patients who were able and willing to attend FLS had lower risk of subsequent fractures and mortality than non-attenders. Patients who were adherent to AOD had lower risk of subsequent fractures than non-adherent patients, emphasizing the importance of adherence in secondary fracture prevention.

Keywords: Fracture liaison services; Men; Mortality; Secondary fracture prevention; Subsequent fracture; Women.

MeSH terms

Aged
Aged, 80 and over
Bone Density Conservation Agents* / administration & dosage
Bone Density Conservation Agents* / therapeutic use
Female
Humans
Male
Middle Aged
Norway / epidemiology
Osteoporosis / drug therapy
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / mortality
Osteoporotic Fractures* / prevention & control
Risk Assessment / methods
Secondary Prevention* / methods

Substances

Bone Density Conservation Agents