Evaluation of minimal fracture liaison service resource : costs and survival in secondary fracture prevention-a prospective one-year study in South-Finland

Background Fracture liaison service (FLS) is a secondary prevention model for identification of patients at risk for fragility fractures. Aims This study was conducted to evaluate the number and costs of secondary prevention of low-energy fractures in the city of Kouvola in Finland. Methods Women aged >= 45 years and men >= 60 years treated in the emergency department with a low-energy fracture were identified. Laboratory testing, BMI, and DXA scans were performed. Fracture Risk Assessment Tool was used. The direct FLS costs were calculated. Survival was analyzed using univariate and multivariate analysis and the life-table method. Results 525 patients with 570 fractures were identified. The mean age of women was 73.8 years and of men 75.9 years. Most patients sustained wrist (31%), hip (21%) or proximal humerus (12%) fractures. 41.5% of the patients had osteoporosis according to DXA scans. 62% of patients used calcium and vitamin D daily and 38% started anti-osteoporotic medication. Protective factors for survival were: age <80 years, female sex, and S-25OHD concentration of 50-119 nmol/L. Excess mortality was highest among patients with a fracture of the femur. The total annual direct costs of FLS were 1.3% of the costs of all fractures. Discussion Many low-energy fracture types were associated with excess mortality. The use of anti-osteoporotic medication was not optimal. Conclusions FLS increased the catchment of low-energy fracture patients and was inexpensive. However, identification, evaluation and post-fracture assessment of patients should be expedited. Rehabilitation of hip fracture patients needs to be improved.Peer reviewe

High-Power 1.48-μm Wafer-Fused Optically Pumped Semiconductor Disk Laser

An output power up to 5 W at 1.48- m wavelength is achieved from an optically pumped semiconductor disk laser. An active region composed of an AlGaInAs/InP heterostructure grown on an InP substrate was wafer fused with an AlGaAs/GaAs Bragg reflector grown on a GaAs substrate. An intracavity diamond heatspreader bonded to the gain structure surface provides efficient heat removal from the active element. The results further validate that the wafer fusion technique offers a flexible platform for high-power disk lasers in a wide wavelength range