Spanish National Hip Fracture Registry (RNFC) : First-year results and comparison with other registries and prospective multi-centric studies from Spain

Fundamentos: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. Métodos: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. Resultados: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). Conclusiones: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantes.OBJECTIVE: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS: We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences

Registro Nacional de Fracturas de Cadera (RNFC): Resultados del primer año y comparación con otros registros y estudios multicéntricos españoles

Background: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. Methods: We included persons 75 years of age or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. Results: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). Conclusions: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differencesFundamentos: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. Métodos: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. Resultados: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). Conclusiones: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantesThe RNFC has been financed through donations by AMGEN SA, UCB Pharma, Abbott Laboratories and FAES Farma, as well as a Research Grant from the Fundación Mutua Madrileña (AP169672018)

Situació i avaluació de l’atenció de la fractura de maluc en la gent gran a Catalunya. Estudi poblacional entre els anys 2012 i 2016

La fractura de maluc (FM) és un problema primordial de salut en la gent gran. Aquest procés, a més de tenir associada una elevada mortalitat, pot ocasionar deteriorament important de la qualitat de vida i ser font de discapacitats i d’una elevada utilització de recursos sanitaris. En aquest estudi poblacional desenvolupat entre els anys 2012-2016 a la població catalana major de 64 anys amb fractura de maluc, observem que aquest procés afecta especialment persones amb una gran comorbiditat associada que, juntament amb l’edat, provoca pitjors resultats en els 3 anys posteriors a la FM inicial. Observem que el 74,4 % de les FM ocorregudes en aquests 5 anys es van donar en dones i el 25,6 % en homes. Les dones tenien una edat mitjana de 85,3 anys i els homes de 83,8 anys. Hem analitzat la càrrega de morbiditat segons els nivells de risc definits per a la població general de Catalunya major de 64 anys, denominats grups de morbiditat ajustats (GMA). Aquests GMA són un agrupador de morbiditat comparable a d’altres existents en el mercat, però s’han desenvolupat amb les dades pròpies del sistema sanitari local, que permeten generar una adequada estratificació poblacional i són capaces d’identificar poblacions diana de risc. L’anàlisi indica que a Catalunya, el 5 % de la població presenta un risc màxim i el 17 % un risc alt, mentre que en les persones que han sofert una FM aquests percentatges són superiors: d’un 14 % i un 31 %, respectivament. La supervivència disminueix a mesura que incrementa l’edat i també disminueix amb l’augment de l’estrat de risc (increment del nombre de comorbiditats i d’utilització de serveis sanitaris): dels que mostren un estrat de risc baix, el 70 % continuaran vius al cap de 3 anys, mentre que dels que el mostren molt alt, només un 39 %. Per altra banda, s’ha analitzat la despesa anual per persona durant l’any posterior a la FM, i s’ha observat que és més de tres vegades superior que la de l’any anterior. Durant el segon any posterior a la FM, la despesa continua sent superior a la de l’any anterior a l’esdeveniment. Segons la distribució percentual de la despesa, l’any anterior a la FM, un 30 % era farmacèutica i un 25 % era d’hospitalització. Mentre que el primer any posterior a la FM, la despesa per hospitalització passa a ser el 40 %, la sociosanitària el 33 % i la farmacèutica el 10 % del total. En el segon i tercer any posteriors a la FM, la distribució de la despesa va ser força semblant a la de l’any anterior a la FM.Hip fracture (HF) is a primary health problem in the elderly. This process, in addition to having a high mortality associated, can lead to a significant deterioration in the quality of life, can be source of disabilities and can cause a high use of health resources. In this population study, carried out between 2012 and 2016 with Catalonia citizens over 64 years old who had previously suffered hip fracture, it was noted that this process particularly affects people who have a great associated comorbidity, which together with age has fatal results in the 3 years after the initial HF. We analysed the burden of morbidity according to the levels of risk defined for the general population of Catalonia over 64 in the so-called adjusted morbility groups (GMA). These GMAs are a morbidity group comparable to those existing, but developed with the data of the Catalan health system, which allows to generate adequate population stratification and to identify target populations at risk. Thus, among the general population of Catalonia, 5 % present maximum risk and 17 % present high risk, whereas among people who have suffered HF these percentages are higher –14 % and 31 %, respectively. Survival decreases as age increases, and it also declines with a higher risk morbidity value (increase in the number of comorbidities and the use of health services): from those in a low risk stratum, 70 % will remain alive 3 years later, while from those in a high risk stratum, only 39 % will. Additionally, the annual cost per person has been analysed for the year after the FM, and it has been observed that it is more than three times higher than the one for the previous year. During the second year after the HF, the cost continues to be higher than that of the year before the event. From the expense in the year before the HF, 30 % was pharmaceutical and 25 % covered hospitalization costs. While the first year after the HF, hospitalization costs amount to 40 %, skilled nurse facilities take up 33 % and pharmacy 10 %. The second and third years after the HF the expense distribution was quite similar to that of the year before the HF

Situació i avaluació de l’atenció de la fractura de maluc en la gent gran a Catalunya. Estudi poblacional entre els anys 2012 i 2016

La fractura de maluc (FM) és un problema primordial de salut en la gent gran. Aquest procés, a més de tenir associada una elevada mortalitat, pot ocasionar deteriorament important de la qualitat de vida i ser font de discapacitats i d’una elevada utilització de recursos sanitaris. En aquest estudi poblacional desenvolupat entre els anys 2012-2016 a la població catalana major de 64 anys amb fractura de maluc, observem que aquest procés afecta especialment persones amb una gran comorbiditat associada que, juntament amb l’edat, provoca pitjors resultats en els 3 anys posteriors a la FM inicial. Observem que el 74,4 % de les FM ocorregudes en aquests 5 anys es van donar en dones i el 25,6 % en homes. Les dones tenien una edat mitjana de 85,3 anys i els homes de 83,8 anys. Hem analitzat la càrrega de morbiditat segons els nivells de risc definits per a la població general de Catalunya major de 64 anys, denominats grups de morbiditat ajustats (GMA). Aquests GMA són un agrupador de morbiditat comparable a d’altres existents en el mercat, però s’han desenvolupat amb les dades pròpies del sistema sanitari local, que permeten generar una adequada estratificació poblacional i són capaces d’identificar poblacions diana de risc. L’anàlisi indica que a Catalunya, el 5 % de la població presenta un risc màxim i el 17 % un risc alt, mentre que en les persones que han sofert una FM aquests percentatges són superiors: d’un 14 % i un 31 %, respectivament. La supervivència disminueix a mesura que incrementa l’edat i també disminueix amb l’augment de l’estrat de risc (increment del nombre de comorbiditats i d’utilització de serveis sanitaris): dels que mostren un estrat de risc baix, el 70 % continuaran vius al cap de 3 anys, mentre que dels que el mostren molt alt, només un 39 %. Per altra banda, s’ha analitzat la despesa anual per persona durant l’any posterior a la FM, i s’ha observat que és més de tres vegades superior que la de l’any anterior. Durant el segon any posterior a la FM, la despesa continua sent superior a la de l’any anterior a l’esdeveniment. Segons la distribució percentual de la despesa, l’any anterior a la FM, un 30 % era farmacèutica i un 25 % era d’hospitalització. Mentre que el primer any posterior a la FM, la despesa per hospitalització passa a ser el 40 %, la sociosanitària el 33 % i la farmacèutica el 10 % del total. En el segon i tercer any posteriors a la FM, la distribució de la despesa va ser força semblant a la de l’any anterior a la FM.Hip fracture (HF) is a primary health problem in the elderly. This process, in addition to having a high mortality associated, can lead to a significant deterioration in the quality of life, can be source of disabilities and can cause a high use of health resources. In this population study, carried out between 2012 and 2016 with Catalonia citizens over 64 years old who had previously suffered hip fracture, it was noted that this process particularly affects people who have a great associated comorbidity, which together with age has fatal results in the 3 years after the initial HF. We analysed the burden of morbidity according to the levels of risk defined for the general population of Catalonia over 64 in the so-called adjusted morbility groups (GMA). These GMAs are a morbidity group comparable to those existing, but developed with the data of the Catalan health system, which allows to generate adequate population stratification and to identify target populations at risk. Thus, among the general population of Catalonia, 5 % present maximum risk and 17 % present high risk, whereas among people who have suffered HF these percentages are higher –14 % and 31 %, respectively. Survival decreases as age increases, and it also declines with a higher risk morbidity value (increase in the number of comorbidities and the use of health services): from those in a low risk stratum, 70 % will remain alive 3 years later, while from those in a high risk stratum, only 39 % will. Additionally, the annual cost per person has been analysed for the year after the FM, and it has been observed that it is more than three times higher than the one for the previous year. During the second year after the HF, the cost continues to be higher than that of the year before the event. From the expense in the year before the HF, 30 % was pharmaceutical and 25 % covered hospitalization costs. While the first year after the HF, hospitalization costs amount to 40 %, skilled nurse facilities take up 33 % and pharmacy 10 %. The second and third years after the HF the expense distribution was quite similar to that of the year before the HF

Situació i avaluació de l'atenció de la fractura de maluc en la gent gran a Catalunya : estudi poblacional entre els anys 2012 i 2016 /

Departament responsable de la tesi: Departament de Medicina.La fractura de maluc (FM) és un problema primordial de salut en la gent gran. Aquest procés, a més de tenir associada una elevada mortalitat, pot ocasionar deteriorament important de la qualitat de vida i ser font de discapacitats i d'una elevada utilització de recursos sanitaris. En aquest estudi poblacional desenvolupat entre els anys 2012-2016 a la població catalana major de 64 anys amb fractura de maluc, observem que aquest procés afecta especialment persones amb una gran comorbiditat associada que, juntament amb l'edat, provoca pitjors resultats en els 3 anys posteriors a la FM inicial. Observem que el 74,4 % de les FM ocorregudes en aquests 5 anys es van donar en dones i el 25,6 % en homes. Les dones tenien una edat mitjana de 85,3 anys i els homes de 83,8 anys.Hem analitzat la càrrega de morbiditat segons els nivells de risc definits per a la població general de Catalunya major de 64 anys, denominats grups de morbiditat ajustats (GMA). Aquests GMA són un agrupador de morbiditat comparable a d'altres existents en el mercat, però s'han desenvolupat amb les dades pròpies del sistema sanitari local, que permeten generar una adequada estratificació poblacional i són capaces d'identificar poblacions diana de risc.L'anàlisi indica que a Catalunya, el 5 % de la població presenta un risc màxim i el 17 % un risc alt, mentre que en les persones que han sofert una FM aquests percentatges són superiors: d'un 14 % i un 31 %, respectivament. La supervivència disminueix a mesura que incrementa l'edat i també disminueix amb l'augment de l'estrat de risc (increment del nombre de comorbiditats i d'utilització de serveis sanitaris): dels que mostren un estrat de risc baix, el 70 % continuaran vius al cap de 3 anys, mentre que dels que el mostren molt alt, només un 39 %.Per altra banda, s'ha analitzat la despesa anual per persona durant l'any posterior a la FM, i s'ha observat que és més de tres vegades superior que la de l'any anterior. Durant el segon any posterior a la FM, la despesa continua sent superior a la de l'any anterior a l'esdeveniment. Segons la distribució percentual de la despesa, l'any anterior a la FM, un 30 % era farmacèutica i un 25 % era d'hospitalització. Mentre que el primer any posterior a la FM, la despesa per hospitalització passa a ser el 40 %, la sociosanitària el 33 % i la farmacèutica el 10 % del total. En el segon i tercer any posteriors a la FM, la distribució de la despesa va ser força semblant a la de l'any anterior a la FM.Hip fracture (HF) is a primary health problem in the elderly. This process, in addition to having a high mortality associated, can lead to a significant deterioration in the quality of life, can be source of disabilities and can cause a high use of health resources. In this population study, carried out between 2012 and 2016 with Catalonia citizens over 64 years old who had previously suffered hip fracture, it was noted that this process particularly affects people who have a great associated comorbidity, which together with age has fatal results in the 3 years after the initial HF. We analysed the burden of morbidity according to the levels of risk defined for the general population of Catalonia over 64 in the so-called adjusted morbility groups (GMA). These GMAs are a morbidity group comparable to those existing, but developed with the data of the Catalan health system, which allows to generate adequate population stratification and to identify target populations at risk. Thus, among the general population of Catalonia, 5 % present maximum risk and 17 % present high risk, whereas among people who have suffered HF these percentages are higher -14 % and 31 %, respectively. Survival decreases as age increases, and it also declines with a higher risk morbidity value (increase in the number of comorbidities and the use of health services): from those in a low risk stratum, 70 % will remain alive 3 years later, while from those in a high risk stratum, only 39 % will. Additionally, the annual cost per person has been analysed for the year after the FM, and it has been observed that it is more than three times higher than the one for the previous year. During the second year after the HF, the cost continues to be higher than that of the year before the event. From the expense in the year before the HF, 30 % was pharmaceutical and 25 % covered hospitalization costs. While the first year after the HF, hospitalization costs amount to 40 %, skilled nurse facilities take up 33 % and pharmacy 10 %. The second and third years after the HF the expense distribution was quite similar to that of the year before the HF

A Delphi consensus on the management of spanish patients with osteoporosis at high risk of fracture: OSARIDELPHI study

Summary The OSARIDELPHI study evaluated the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. The results provide expert-based recommendations for prevention, diagnosis, and treatment related to fracture risk. Therefore, the study facilitates clinical decision-making for managing this patient's profile. Purpose To evaluate the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. Methods A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with assessments on a 9-point Likert scale. Item selection was based on acceptance by ≥ 66.6% of panel experts and the agreement of the scientific committee. In round 2, the same panelists evaluated non-consensus items in round 1. Results A total of 80 panelists participated in round 1; of these, 78 completed the round 2 survey. In round 1, 122 items from 4 dimensions (definition of fracture risk: 11 items, prevention and diagnosis: 38 items, choice of treatment: 24 items, and treatment-associated quality of life: 49 items) were evaluated. The consensus was reached for 90 items (73.8%). Panelists agreed that categorizing high risk, very high risk, or imminent risk determines secondary prevention actions (97.5%). Experts agreed that treatment with bone-forming drugs should be considered in case of a very high risk of fracture, and a sequential change to antiresorptive drugs should be made after 1-2 years (97.5%). Panelists also recommended corrective action plans for non-adherent patients to improve adherence (97.5%). A total of 131 items were finally accepted after round 2. Conclusion This Delphi study provides expert-based recommendations on clinical decision-making for managing patients with osteoporosis at high risk of fracture.Funding. This study was sponsored by STADA. Acknowledgements. The authors acknowledge Lola Andreu-Pérez and Alicia Subtil-Rodríguez (both from Evidenze Clinical Research) for project coordination and editorial assistance based on the authors’ input

La salud móvil en atención primaria. Nuevos desafíos en el desarrollo de soluciones para promover la actividad física y el bienestar

Resumen: El uso de dispositivos inteligentes como los teléfonos móviles (smpartphones) o relojes inteligentes (smartwatch) para promover la actividad física y el bienestar se ha incrementado en los últimos años entre los pacientes y los profesionales en atención primaria. Este cambio se ve impulsado por el acceso de los pacientes y de los profesionales a un gran catálogo de aplicaciones en salud, las cuales pueden complementar la prestación de servicios y promover el empoderamiento de los pacientes en su propia salud y los estilos de vida. Estas aplicaciones se están empezando a integrar con áreas como la inteligencia artificial (IA), el internet de las cosas médicas (IoMT) y el almacenamiento de datos en la nube, entre otros sistemas tecnológicos emergentes, ofreciendo un nuevo enfoque complementario a la práctica clínica conocida hasta el momento. A pesar del gran potencial, existen numerosas limitaciones y grandes desafíos para su implementación plena en la práctica clínica. Abstract: The use of smart devices such as mobile phones (smartphones) or smart watches (smartwatch) to promote physical activity and well-being has increased in recent years among patients and professionals in primary care. This change is driven by the access of patients and professionals to a large catalog of health applications, which can complement the provision of services and promote the empowerment of patients in their own health and lifestyles. These applications are beginning to be integrated with areas such as Artificial Intelligence (AI), the Internet of Medical Things (IoMT) and data storage in the cloud, among other emerging technological systems, offering a new complementary approach to clinical practice known so far. Despite the great potential, there are numerous limitations and major challenges for its full implementation in clinical practice

Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards

Summary REFRA-FLS is a new registry in Spain aimed at identifying individuals over 50 years of age with a fragility fracture. Using this registry, we found hip fracture is the most prevalent fracture. Treatment for osteoporosis was 87.7%, with 65.3% adherence. REFRA-FLS provides fundamental data in the study of fragility fractures. Purpose Fragility fractures are a growing public health concern in modern-aged societies. Fracture Liaison Services (FLS) have been shown to successfully lower rates of secondary fractures. A new registry (REFRA-FLS) has been created to moni tor quality indicators of FLS units in Spain and to explore the occurrence and characteristic of fragility fractures identifed by these centers. Methods We conducted a prospective cohort study based on fragility fractures recorded in the REFRA-FLS registry. Par ticipants were individuals 50 years or above who sufered a low energy fragility fracture identifed by the 10 participating FLS units during the study period. The type of FLS unit, the characteristics of the individuals at baseline, along with patient outcomes as quality indicators among those who completed 1 year of follow-up were analyzed. Results A total of 2965 patients and 3067 fragility fractures were identifed, and the most frequent locations were hip (n=1709, 55.7%) and spine (n=492, 16.0%). A total of 43 refractures (4.5%) and 46 deaths (4.9%) were observed among 948 individuals in the follow-up analyses. Time from fracture to evaluation was less than 3 months in 76.7% of individuals. Osteoporosis treatment was prescribed in 87.7%, and adherence was 65.3% in Morisky–Green test. Conclusion Our results provide a comprehensive picture of fragility fractures identifed in FLS units from Spain. Overall, quality indicators are satisfactory although a much higher use of DXA would be desirable. As the registry grows with the incorporation of new FLS units and longer follow-up, incoming analyses will provide valuable insight

Registro Nacional Español de Fracturas de Cadera (RNFC): descripción de sus objetivos, metodología e implementación

To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality.Sin financiaciónNo data JCR 20180.244 SJR (2018) Q3, 77/114 Geriatrics and Gerontology, 1828/2844 Medicine (miscellaneous); Q4, 28/36 AgingNo data IDR 2018UE

Spanish national registry of major osteoporotic fractures (REFRA) seen at fracture liaison services (FLS). Objectives and quality standards

REFRA-FLS is a new registry in Spain aimed at identifying individuals over 50 years of age with a fragility fracture. Using this registry, we found hip fracture is the most prevalent fracture. Treatment for osteoporosis was 87.7%, with 65.3% adherence. REFRA-FLS provides fundamental data in the study of fragility fractures. Purpose: fragility fractures are a growing public health concern in modern-aged societies. Fracture Liaison Services (FLS) have been shown to successfully lower rates of secondary fractures. A new registry (REFRA-FLS) has been created to monitor quality indicators of FLS units in Spain and to explore the occurrence and characteristic of fragility fractures identified by these centers. Methods: we conducted a prospective cohort study based on fragility fractures recorded in the REFRA-FLS registry. Participants were individuals 50 years or above who suffered a low energy fragility fracture identified by the 10 participating FLS units during the study period. The type of FLS unit, the characteristics of the individuals at baseline, along with patient outcomes as quality indicators among those who completed 1 year of follow-up were analyzed. Results: a total of 2965 patients and 3067 fragility fractures were identified, and the most frequent locations were hip (n = 1709, 55.7%) and spine (n = 492, 16.0%). A total of 43 refractures (4.5%) and 46 deaths (4.9%) were observed among 948 individuals in the follow-up analyses. Time from fracture to evaluation was less than 3 months in 76.7% of individuals. Osteoporosis treatment was prescribed in 87.7%, and adherence was 65.3% in Morisky-Green test. Conclusion: our results provide a comprehensive picture of fragility fractures identified in FLS units from Spain. Overall, quality indicators are satisfactory although a much higher use of DXA would be desirable. As the registry grows with the incorporation of new FLS units and longer follow-up, incoming analyses will provide valuable insight