Bone Abstracts

Objectives: Fracture Liaison Services (FLS) aim to prevent secondary fractures by ensuring quality care for patients over 50. This study assessed the relationship between age and the risk of refracture and mortality within an established FLS.

Methods: We retrospectively reviewed 5320 patients seen by Aneurin Bevan FLS (AB-FLS) from January 2022 to December 2024 using national FLS Database (FLS-DB). Patients were stratified into five age groups by decade. Patients were followed longitudinally for re-fractures and mortality until 31^st December 2025.

Results: The cohorts mean age was 78.4 years (range 50105) with a marked female predominance (77.9%, P 0.0001). Nearly half of patients had a prior fracture history (49.1%, n2,608), with a mean interval of 6 years (range 036). Most patients lived in the community (94.4%), while 5.6% resided in care homes. Osteoporosis treatment was initiated in 65.5% of patients (n3,485/5,320). Over a four-year follow-up period, 82.4% of patients (n4,386/5,320) experienced no re-fractures. Overall, 17.6% (n931/5,320) sustained a re-fracture, with a mean time to event of 301 days (range 21,088 days). At 12 months, 11.1% of patients (n593/5,320) had re-fractured. One-year re-fracture rates rose from 6.2% in patients aged 5059 to 12.7% in those aged 8089 (P 0.0007), with similarly increasing overall re-fracture rates from 10.9% to 18.6% (P 0.0007) across the same age groups. Although the one-year re-fracture rate was slightly lower in patients aged ≥90 years (11.2%), overall, re-fracture remained high at 18.2%. By four years, 23.7% of the cohort had died (n1,259). One-year mortality increased steadily from 1.2% in the 5059 age group to 19.8% in those aged 8089 (P 0.0001), rising sharply to 36.8% in patients aged ≥90 years (P 0.0001). Overall mortality followed the same pattern, increasing from 1.8% at ages 5059 to 28.4% at 8089 (P 0.0001), and reaching 48.7% in those aged ≥90 years (P 0.0001).

Conclusion: Refracture and mortality increased markedly with age, particularly beyond 70, with the greatest burden observed in the oldest age group. Secondary fracture services should be tailored to better address the needs of this population, ensuring true equity in healthcare delivery.