TY - JOUR
T1 - Establishing a hospital based fracture liaison service to prevent secondary insufficiency fractures
AU - Noordin, Shahryar
AU - Allana, Salim
AU - Masri, Bassam A.
N1 - Funding Information:
A fracture liaison service (FLS) is a multidisciplinary system approach to reducing subsequent fracture risk in patients with a recent fragility fracture due to compromised bone health by identifying them at or close to the time when they are treated at the hospital for fracture and providing them with easy access to osteoporosis care [60]. In the FLS model of care, in order to reduce the risk of another fracture, the patient is automatically enrolled for assessment of his/her risk for a secondary fracture, and started on treatment needed to improve bone quality and strength. Kaufman et al. [61] have shown that when compared to other models such as referral letters to primary care physicians or endocrinologists, the FLS model results in a higher rate of diagnosis and treatment with less attrition in the posffracture phase. Many programs have evaluated the efficacy of systems for preventing secondary fractures, known as fracture liaison service (FLS) [15]. The International Osteoporosis Foundation (IOF) fracture working group [16] in 2013 published a detailed analysis showed that internationally, the rate of evidence-based treatment for osteoporosis after a fragility fracture ranged from 2% to 25%. The poor postfracture care has been largely attributed to lack of ownership of osteoporosis by any single medical specialty. In several countries, the local health authorities have developed fracture care systems with a view to enhance post-fracture care [15,17–41] Because setting up and maintaining a FLS requires considerable effort, some stakeholder organizations have developed resources that provide motivation and methodologies to improve the chance of success [7]. The International Osteoporosis Foundation has Capture the Fracture [42] whose goals are to support the implementation of FLS internationally by providing implementation guides, standards of post-fracture care, and national toolkits in addition to relevant manuscripts. In the United States, National Bone Health Alliance (a public-private partnership) has Fracture Prevention Central [43] whose goal is to reduce fractures in the USA by 20% by the year 2020. With the passage of time, studies have shown that in addition to treatment initiation, patients have also followed up with osteoporosis management [18,22–24,26,33] Reports have shown that these programs resulted in decreased secondary fracture risk and mortality over time [23,31,40,44–48] With the projected increase in fragility fractures and the associated burden to local health care systems, these extended fracture care services have also been shown to be cost effective [17,31,37,48–59] These cost savings are achieved by osteoporosis management and also by opportunity costs of decreased fracture rates and increased quality-adjusted life years. The international Osteoporosis Foundation in 2013 [16] recommended setting up Fracture Liason Services (FLS) for prevention of secondary fractures. FLS is a coordinated, collaborative approach to the capture, referral and management of patients who sustain a MTF due to osteoporosis in order to prevent future fractures.
Publisher Copyright:
© 2017 IJS Publishing Group Ltd
PY - 2018/6
Y1 - 2018/6
N2 - In the aging population worldwide, osteoporosis is a relatively common condition and a major cause of long-term morbidity. Initial fragility fractures can lead to subsequent fractures. After a vertebral fracture, the risk of any another fracture increases 200% and that of a subsequent hip fracture increases 300%. For starting a hospital based Fracture Liaison Service (FLS) program, the nucleus is based on a physician champion, a FLS coordinator, and a nurse manager. A Fracture Liaison Service (FLS) is a multidisciplinary system approach to reducing subsequent fracture risk in patients with a recent fragility fracture due to compromised bone health by identifying them at or close to the time when they are treated at the hospital for fracture and providing them with easy access to osteoporosis care. It has been shown that when compared to other models such as referral letters to primary care physicians or endocrinologists, the FLS model results in a higher rate of diagnosis and treatment with less attrition in the posffracture phase. Insufficiency fracture care requires more than surgery to stabilize a fractured bone. The FLS program provides an opportunity to treat osteoporosis from a public health perspective rather than leaving this to the whims of individual physicians. This is achieved by providing a seamless integration of care by health care providers, nursing staff and administration. The FLS can be adapted to any model of care including academic health systems. FLS provides a holistic approach to identify patients as well as to provide evidence-based interventions to prevent subsequent fractures. The long term goal is that internationally FLS will result in in decreased fracture-related morbidity, mortality and overall health care expenditure.
AB - In the aging population worldwide, osteoporosis is a relatively common condition and a major cause of long-term morbidity. Initial fragility fractures can lead to subsequent fractures. After a vertebral fracture, the risk of any another fracture increases 200% and that of a subsequent hip fracture increases 300%. For starting a hospital based Fracture Liaison Service (FLS) program, the nucleus is based on a physician champion, a FLS coordinator, and a nurse manager. A Fracture Liaison Service (FLS) is a multidisciplinary system approach to reducing subsequent fracture risk in patients with a recent fragility fracture due to compromised bone health by identifying them at or close to the time when they are treated at the hospital for fracture and providing them with easy access to osteoporosis care. It has been shown that when compared to other models such as referral letters to primary care physicians or endocrinologists, the FLS model results in a higher rate of diagnosis and treatment with less attrition in the posffracture phase. Insufficiency fracture care requires more than surgery to stabilize a fractured bone. The FLS program provides an opportunity to treat osteoporosis from a public health perspective rather than leaving this to the whims of individual physicians. This is achieved by providing a seamless integration of care by health care providers, nursing staff and administration. The FLS can be adapted to any model of care including academic health systems. FLS provides a holistic approach to identify patients as well as to provide evidence-based interventions to prevent subsequent fractures. The long term goal is that internationally FLS will result in in decreased fracture-related morbidity, mortality and overall health care expenditure.
KW - Fracture liaison service
KW - Fragility fracture
KW - Insufficiency fracture
KW - Osteoporosis
UR - http://www.scopus.com/inward/record.url?scp=85034758042&partnerID=8YFLogxK
U2 - 10.1016/j.ijsu.2017.09.010
DO - 10.1016/j.ijsu.2017.09.010
M3 - Review article
C2 - 28919380
AN - SCOPUS:85034758042
SN - 1743-9191
VL - 54
SP - 328
EP - 332
JO - International Journal of Surgery
JF - International Journal of Surgery
ER -
