Preventing re-fractures in Western Sydney: three-year outcomes of an Australian fracture liaison service utilising a novel automated fracture-finding Tool

Fragility fractures impose a major burden on health systems, particularly in socioeconomically disadvantaged regions. Western Sydney, home to some of Australia’s most disadvantaged groups, faces unique challenges in osteoporosis care. This study evaluated the effectiveness of a hospital-based Fracture Liaison Service (FLS) in reducing refracture rates amongst the most vulnerable. Fragility fractures are an important predictor of future fractures. Secondary fracture prevention brings significant benefits for patients, clinicians and healthcare systems. Fracture liaison services (FLS) are established models of care to prevent secondary fractures. However not all FLSs are equal, with differences in models of care and target population. Westmead Hospital, a major tertiary centre in Western Sydney, established a FLS in 2019. This study compares one and three-year refracture rates between patients managed by the FLS and a control group - patients approached by FLS but lost to follow-up, non-attenders or those who declined treatment. Fracture cases were identified using an automated ICD-10/SNOMED-based fracture finding tool. Baseline variables included age, sex, index fracture site, and Charlson Comorbidity Index (CCI). This study included 406 patients who presented to the Westmead Emergency Department with a minimal-trauma fracture between 2019 and 2022. Of these, 279 were managed by the FLS and 127 served as controls. Baseline characteristics were similar across groups, with the exception that FLS participants were more likely to have sustained a fracture within the preceding three years (10.0% vs 1.6%, p < 0.005). At three years, refracture rates were significantly lower in FLS patients (10.4% vs 23.6%, p < 0.001), with no difference at one year (4.3% vs 5.5%, p = 0.61). FLS participation was associated with a ~ 70% reduction in refracture risk between 1 and 3 years after index fracture (HR 0.309, p < 0.0005). FLS attendance was associated with a significant reduction in refractures, with less than half the risk at three years, despite the higher prior incidence of fractures. No benefit was seen at one year, indicating that FLS evaluation may require a longer latency period to establish anti-fracture efficacy.