The impact of social deprivation on completion of a bone health evaluation following a fragility fracture and referral by a fracture liaison service

Background: A Fracture Liaison Service (FLS) can improve patient evaluation and treatment for osteoporosis after a fragility fracture. This study examined the sociodemographic factors associated with failure to present for bone health evaluation following a fragility fracture despite referral by a FLS to identify at risk groups. Methods: All patients at one tertiary orthopedic center who sustained a fragility fracture between January 2022 and December 2023 and were referred for bone health evaluation through the FLS were eligible for inclusion. Demographic data were obtained through the electronic medical record (EMR). Zip codes were utilized to determine the area deprivation index (ADI) for each patient. Those who did not complete any appointment were designated "no appointment". Time from referral to appointment completion and completion of a dual-energy X-ray absorption (DEXA) scan was also recorded. Results: 256 patients, 36 male and 219 female, were included in this study. 68 patients (26.6%) fell into the no appointment group. Both state and national ADI were significantly lower in the completed appointment group. DEXA non-completion was associated with 90% decreased odds of completing the first scheduled appointment. Conclusions: Living in an area of high social deprivation is associated with non-completion of a bone health evaluation following a fragility fracture. DEXA status was also predictive of likelihood of appointment completion. Efforts should be implemented to improve the efficacy of the FLS by targeting groups at higher risk of appointment non-completion. Level of Evidence: III.