The first reported fracture liaison service (FLS) for vertebral fractures in China: is muscle the missing gap?

Summary Fracture liaison services (FLS) have been implemented worldwide, but we present one of the first reported experiences in China. Only 1 out of 226 patients had a secondary fracture within 1 year. This serves as a platform to improving solutions and decreasing imminent fractures for future use nationwide in China. Introduction Fracture liaison services (FLS) have been implemented worldwide but we present one of the first reported experiences in China. Vertebral fragility fracture is one of the earliest fracture to occur. The objective of this study was to implement a dedicated fracture service to decrease imminent fractures for future use nationwide in China. Methods Patients 50 years or older with a recent vertebral compression fracture were recruited. All patients were offered investigation with DXA scan and blood taking. Treatment was provided with calcium and vitamin D supplements and denosumab injections. The primary outcome was the imminent fracture rate or the re-fracture rate occurring within 2 years of the initial one. Secondary outcomes were bone mineral density (BMD), treatment initiation, adherence to drug, compliance to follow-up, falls, mortality, pain, quality of life, pain-related disability with Roland-Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Results Two hundred twenty-six patients ( n = 226) were analyzed. 0.4% ( n = 1) had an imminent fracture within 2 years. 11.1% ( n = 25) had a fall within 2 years, in which 1 resulted in a major osteoporotic fracture. 7.1% died ( n = 16) within the 2-year time period. 97.8% ( n = 221) underwent BMD investigation with an initial DXA scan. One hundred percent ( n = 226) had treatment initiation and were prescribed with Denosumab injections. 89.8% ( n = 203) were compliant and showed complete adherence to drug therapy over the 2 years. Pain, quality of life, and disability were significantly improved. Conclusion This is the first reported fracture liaison service for vertebral fracture patients reported in China. Future FLS should incorporate muscle and sarcopenic assessments as a routine, and also research on novel interventions in this area would significantly improve patient outcomes.