Independent predictors of functional loss and refractures in patients with femur fracture: Follow-up at 6 and 18 months in a Fracture Liaison Service

Abstract

Background: In elderly patients hospitalized for a femur fracture, this study aimed to evaluate the functional evolution, and to estimate the incidence of second fractures at 6 and 18 months after hospital discharge. Patients and methods: A longitudinal prospective study was designed at an Orthogeriatric Unit after implementing a Fracture Liaison Service (FLS). The variables collected included the baseline demographic and clinical characteristics of the patients, and the outcome variables on discharge, at 6 and 18 months of follow-up. Logistic regressions models were applied to identify independent predictors of functional evolution. Results: 478 patients were admitted. Independent predictors of functional loss at follow-up were institutionalisation, severe dependence either prior to and on discharge, delirium, protein malnutrition, prior acute myocardial infarction, GFR < 30 ml/min/1.73 m2 and not receiving treatment for osteoporosis on discharge. Patients attending follow-up appointments presented improved compliance with osteoporosis treatment both at 6 and 18 months. A lower number of 2nd fractures were recorded at 18 months for patients who attended their appointments (4.8% vs 12.1%, p = 0.01). At 6 and 18 months follow-up, a lower rate of readmission was recorded (7% vs 15.3%, p = 0.006), (9.6% vs 25.6%, p < 0.0001), respectively. Conclusions: The independent predictors of functional loss at 6 and 18 months were institutionalisation, severe dependence either prior to and on discharge, delirium, protein malnutrition, prior acute myocardial infarct, GFR < 30 ml/min/1.73 m2 and not receiving treatment for osteoporosis on discharge. A lower incidence of refractures, a lower readmission rate and a better treatment compliance were observed in patients attending follow-up visits.