A systemwide approach to secondary fracture prevention-the New South Wales Osteoporosis Refracture Prevention Initiative was associated with reduced refractures and was economically sustainable.

UNLABELLED: We assessed the effectiveness and efficiency of the Osteoporosis Refracture Prevention Initiative, which involved widespread Fracture Liaison Service (FLS) implementation throughout New South Wales (NSW), Australia's most populous state. Systemwide FLS implementation was cost-effective and associated with a reduction in minimal trauma refractures requiring hospital admission.

INTRODUCTION

The Osteoporosis Refracture Prevention (ORP) Initiative involved widespread Fracture Liaison Service (FLS) implementation throughout New South Wales (NSW), Australia's most populous state.

PURPOSE: To determine the effectiveness and efficiency of the NSW Osteoporosis Refracture Prevention (ORP) Initiative.

METHODS

Linked administrative data on inpatient admissions, outpatient attendances, Emergency Department (ED) presentations, deaths, and cost was performed. Business-as-usual projections for the expected number of refractures and health service utilisation were generated by extrapolating historical trends. Cost data was measured as National Weighted Activity Units, and an economic analysis included a cost-benefit analysis.

RESULTS

Following ORP implementation in financial year (FY) 2017-2018, 5 years later, in FY 2022-2023, there were 1246 fewer minimal trauma refractures that year which required hospital admission (17% reduction) with 3030 fewer inpatient separations/admissions for refractures (21.4% reduction) compared to expected. Over the 5-year study period, there was a cumulative total of 5329 fewer minimal trauma refractures that required hospital admission (13.6% reduction; p = 0.018) and 11,070 fewer inpatient admissions for refractures (14.7% reduction; p = 0.002) than expected. Probability of a minimal trauma refracture requiring hospital admission within 2 years following an initial minimal trauma fracture decreased from 9.2% to 8.5% (p < 0.0001). For every dollar spent on ORP, an economic return of AUD1.60 was achieved.

CONCLUSION

Systemwide FLS implementation was associated with a reduction in minimal trauma refractures requiring hospital admission. While there are limitations with using "business-as usual" projections as historical controls may have been affected by unknown factors, systemwide FLS implementation was cost-effective and a realistic systemwide model of care to address the burden of osteoporotic fractures.