Preprint · Jan 2026
Comparison of the implementation of the FLS care model and the perception of quality of life in patients over 50 years old who suffered a hip fracture due to bone fragility
By Viruega-Avalos JM, Coronado‐Zarco R, de León AOG
Hip fragility fracture is a sentinel event associated with excess mortality, disability, and loss of independence. The early post-fracture period carries an imminent risk of subsequent fractures, yet secondary prevention remains inconsistently implemented. To compare the effectiveness of a Fracture Liaison Service (FLS) versus usual care in reducing second fractures and refractures, and to evaluate associations with functional status and quality of life in adults aged 50 years or older with hip fragility fracture. Objective: To compare the effectiveness of a Fracture Liaison Service (FLS) versus usual care in reducing second fractures and refractures, and to evaluate associations with functional status and quality of life in adults aged 50 years or older with hip fragility fracture. Methods: We conducted an open-label, controlled, non-randomized clinical trial with 12-month follow-up at a second-level hospital in Mexico City. Overall, 779 patients were analyzed (FLS, n=317; usual care, n=462). Second fracture and refracture were compared using risk ratios (RRs), odds ratios, 95% confidence intervals (CIs), and Fisher’s test. Functional status was assessed using Barthel Index and quality of life using WHOQOL-OLD. Results: Second fracture incidence was significantly lower with FLS than with usual care (5.0% vs 10.4%; RR, 0.49; 95% CI, 0.28–0.84; p=0.0077). Refracture was also markedly reduced (0.6% vs 10.4%; RR, 0.06; 95% CI, 0.01–0.25; p<0.001). At 12 months, mean Barthel scores were higher in the FLS group than in controls (72.22±4.10 vs 70.68±6.75; p<0.001). WHOQOL-OLD showed significantly better satisfaction in the FLS (χ²=210.97; p<0.001; Cramer’s V=0.52).