3694 Upholding equitable access to secondary fracture prevention for adults 80 years and older

Abstract Introduction Fragility fractures increase re-fracture and mortality risk, especially within two years. Fracture Liaison Services (FLS) aim to prevent secondary fractures by ensuring quality care for patients over 50. This study assesses equity of care in an existing FLS for patients above and below 80 years and evaluates re-fracture and mortality outcomes. Methods We retrospectively reviewed 2190 patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) from January–December 2023 using national FLS Database (FLS-DB) data. After excluding 14 patients with missing data, 2176 were categorised as: below 80 and above 80 years. Data on previous fractures, re-fractures, and fracture type (hip/femur, spine, wrist, humerus, pelvis, others) were collected. Patients were followed until March 31, 2025, for re-fractures and mortality. Results The cohort’s mean age was 78.6 years (range: 50–103), with a significant female predominance (76.9%, p < 0.0001). Prior fractures were recorded in 50.7% (n = 1104), with a mean interval of 6 years (range: 0–36). Most (93.3%) lived in the community, 6.7% were in care homes. AB-FLS reviewed 1103 (50.7%) patients aged 50–80 and 1073 (49.3%) aged over 80, with no significant group differences. Female distribution was similar (78.8% vs. 75%). Bone treatment was initiated in 1207 (55.2%) patients. Over 27 months follow-up, 1801 (82.8%) had no re-fracture. Overall, 17.2% (n = 374) re-fractured (mean time: 253 days, range: 2–767 days). A significantly higher patients re-fractured in over 80 years (n = 209, 55.9%, mean 235 days) as compared to under 80 years (n = 165, 44.1%, mean 276 days, p = 0.023). At 12 months, 264 (12.1%) re-fractured: 154 (58.3%) over 80 (mean 137 days) and 110 (41.7%) under 80 (mean 151 days, p = 0.008). By 27 months, 503 patients had died. One-year mortality was 18.6% (n = 387), significantly higher in those over 80s (75.7%, n = 293) than under 80 (24.3%, n = 94, p < 0.0001). Conclusion The AB-FLS has demonstrated equitable care over the consecutive twelve-month period; however, further assessment over a longer timeframe is needed for confirmation. Given the significantly higher risk of re-fracture and mortality in older patients, secondary fracture services should be tailored to better address the needs of this population, ensuring true equity in healthcare.