Incidence of secondary fractures after implementation of different models of FLS secondary prevention programs: Scoping review

As the number of programs aimed at preventing fragility fractures and mitigating the phenomenon of cascade fractures is increasing worldwide, so it is necessary to evaluate the effectiveness of such programs to seek their feasible implementation at regional and global levels. This paper aims to provide an overview focusing on the incidence of secondary fractures after the implementation of any type of fracture liaison service (FLS). To this end, a scoping review was conducted focusing on the identification of clinical evidence reported in systematic reviews of the medical literature in this area. A total of 230 titles were obtained through structured searches in four electronic libraries (updated to September 2023), from which a total of 11 systematic reviews were selected. Tables of methodological characteristics were developed. Different programs such as orthogeriatric units, educational strategies, exercise strategies, screening strategies using DXA or FRAX, and specialist intervention by orthopedic specialists or osteoporosis nurses were found in 20 different countries. The reported incidence of secondary fractures varies between populations and strategies compared depending on the data collected and the type of methodological design used. The incidence of secondary fractures in these 11 systematic reviews ranged from 0 to 37 %. The incidence by intervention is described in the Supplementary Tables of the primary studies.