Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards
Authors: Montoya-Garcia Maria Jose , Carbonell-Abella Cristina , Cancio-Trujillo Jose Manuel , Moro-Álvarez Maria Jesus , Mora-Fernández Jesus , Izquierdo-Avino Rafael , Nogues Xavier , Mesa-Ramos Manuel , San Segundo-Mozo Rosa Maria , Calero-Muñoz Elena , Naves-Diaz Manuel , Olmo-Montes F. Jesus , Duaso Enric ,   GRUPO REFRA-FLS, del Rio Luis , Fernández-Martín Jose Luis , Martínez-Laguna Daniel , Miranda Mª José , Hernández Blanca , Barrera Julia , Vázquez-Gámez Mª Ángeles , Giner Mercè , Mesa-Lampre Pilar , Cebollada-Gadea Leticia , Jordan-Jarque Manuel , Ovejero Crespo Diana , Robles Raya Maria Jose , Arnau Barres Isabel , Martinez Diaz Santos , Moreno-Morillo Ana María , Rodríguez-García José Luis , Márquez de Torres Pilar , Barahona Garibello Natalia Angélica , Carretero Dios Diana , Jiménez Vílchez Antonio José , Mesa Ramos Francisco , Copete Marín Sara Isabel , Justicia Castro María José , Valdés Vílchez Manuel , Fernández Ferreras Trinidad R. , Díaz Aristizabal Urko , Aguilera Ballester Laura , Carnicer Cáceres Jesús , Bienzobas Allue Esperanza , Sénder Laura , del Castillo Piñol Nuria , Cuevas Messenger Paulina , Martínez Águila Mª Dolores , Ros Bertomeu Carme , Lacal Martínez Ana , Fernández Sénder Laura , Pellejà Carnasa Joan , Alvarado Christian , Gamboa Andrés , Alberca Evelyn Irene , Arriaza Sofía Alejandra , Grados Dolors , Sopena Eugenia , Castro Sonia , Estudillo Pilar , Qaneta Rami , Fontova Ramon , Marsol Anna , García Forcada Ignacio , Jordà Gerard , Sánchez Indyra , Gálvez Stefan , Fibla Montse , Rodríguez Javier 
Published: November 2022

Abstract

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 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.