Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

The Importance of Fracture Liaison Services to the Healthcare System: A Review

Author(s): Shaan Patel*, Natasha Faye Daniels, Jiang An Lim, Andrew Kailin Zhou, Azeem Thahir and Matija Krkovic

Volume 19, Issue 1, 2023

Published on: 15 June, 2022

Page: [36 - 41] Pages: 6

DOI: 10.2174/1573397118666220510162127

Price: $65

Abstract

Osteoporosis is an important public health concern, with secondary fragility fractures carrying a poor prognosis. The role of a Fracture Liaison Service (FLS) is to identify fragility fracture patients via investigation and risk assessment. This serves to address the osteoporosis treatment care gap that exists where the majority of patients with a new fragility fracture over 50-years-old fail to receive a bone mass density (BMD) scan and osteoporosis treatment, ultimately receiving inadequate care. Osteoporosis medication is effective in reducing secondary fragility fractures. However, treatment adherence poses a problem. The FLS serves to prevent more serious secondary fragility fractures such as hip fractures. This minimises operative costs and the cost of postoperative care and results in fewer secondary care and care home admissions, increasing healthcare savings. Implementation of the FLS is effective in increasing investigation, treatment initiation, and adherence, with a corresponding decrease in refracture rate and mortality. This paper aims to evaluate the previous osteoporosis treatment care gap, the effectiveness of osteoporosis medications currently available, and finally, the cost and clinical effectiveness of the FLS serving as a secondary prevention tool.

Keywords: Fracture liaison service (FLS), hip fracture, fragility fracture, care gap, cost-effectiveness, clinical effectiveness.

« Previous Next »
Graphical Abstract

[1]
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006; 17(12): 1726-33.
[http://dx.doi.org/10.1007/s00198-006-0172-4] [PMID: 16983459]
[2]
British Geriatrics Society. The care of patients with fragility fracture (Blue Book). [UK]: British Orthopaedic Association 2007. Available from: https://www.bgs.org.uk/sites/default/files/content/attachment/2018-05-02/Blue Book on fragility fracture care.pdf (Accessed on 2020 Nov 1).
[3]
NICE National Institute of Care for Health and Care Excellence.. Osteoporosis: Assessing the risk of fragility fracture. [UK]: National Institute of Care for Health and Care Excellence 2012. Available from: https://www.nice.org.uk/guidance/cg146/resources/osteoporosis-assessing-the-risk-of-fragility-fracture-pdf-35109574194373 (Accessed on 2020 Nov 1).
[4]
Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A. The burden of osteoporotic fractures: A method for setting intervention thresholds. Osteoporos Int 2001; 12(5): 417-27.
[http://dx.doi.org/10.1007/s001980170112] [PMID: 11444092]
[5]
Miller AN, Lake AF, Emory CL. Establishing a fracture liaison service: An orthopaedic approach. J Bone Joint Surg Am 2015; 97(8): 675-81.
[http://dx.doi.org/10.2106/JBJS.N.00957] [PMID: 25878314]
[6]
Treml J, Husk J, Lowe D, Vasilakis N. 2010 Falling standards, broken promises: Report of the national audit of falls and bone health. [UK]: Royal College of Physicians Available from: https://www.rcplondon.ac.uk/projects/outputs/falling-standards-broken-promises-report-national-audit-falls-and-bone-health (Accessed on 2020 Nov 1).
[7]
van der Velde RY, Wyers CE, Teesselink E, et al. Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: Variation by age, sex, geographic location and ethnicity. Bone 2017; 94: 50-5.
[http://dx.doi.org/10.1016/j.bone.2016.10.013] [PMID: 27742502]
[8]
Bessette L, Ste-Marie LG, Jean S, et al. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 2008; 19(1): 79-86.
[http://dx.doi.org/10.1007/s00198-007-0426-9] [PMID: 17641811]
[9]
Premaor MO, Pilbrow L, Tonkin C, Parker RA, Compston J. Obesity and fractures in postmenopausal women. J Bone Miner Res 2010; 25(2): 292-7.
[http://dx.doi.org/10.1359/jbmr.091004] [PMID: 19821769]
[10]
Avenell A, Gillespie WJ, Gillespie LD, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post‐menopausal osteoporosis. Cochrane Database Syst Rev 2005; (3): CD000227.
[11]
Grant AM, Avenell A, Campbell MK, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): A randomised placebo-controlled trial. Lancet 2005; 365(9471): 1621-8.
[http://dx.doi.org/10.1016/S0140-6736(05)63013-9] [PMID: 15885294]
[12]
Conley RB, Adib G, Adler RA, et al. Secondary fracture prevention: Consensus clinical recommendations from a multistakeholder coalition. J Bone Miner Res 2020; 35(1): 36-52.
[http://dx.doi.org/10.1002/jbmr.3877] [PMID: 31538675]
[13]
Khan SA, de Geus C, Holroyd B, Russell AS. Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med 2001; 161(10): 1309-12.
[http://dx.doi.org/10.1001/archinte.161.10.1309] [PMID: 11371259]
[14]
Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001; 285(3): 320-3.
[http://dx.doi.org/10.1001/jama.285.3.320] [PMID: 11176842]
[15]
Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P. Hip fracture patients at risk of second hip fracture: A nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res 2009; 24(7): 1299-307.
[http://dx.doi.org/10.1359/jbmr.090207] [PMID: 19257816]
[16]
Gibson-Smith D, Klop C, Elders PJM, et al. The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000-2010. Osteoporos Int 2014; 25(11): 2555-63.
[http://dx.doi.org/10.1007/s00198-014-2799-x] [PMID: 25001987]
[17]
Mitchell PJ. Fracture Liaison Services: The UK experience. Osteoporos Int 2011; 22(3) (Suppl. 3): 487-94.
[http://dx.doi.org/10.1007/s00198-011-1702-2] [PMID: 21847771]
[18]
Sernbo I, Johnell O. Consequences of a hip fracture: A prospective study over 1 year. Osteoporos Int 1993; 3(3): 148-53.
[http://dx.doi.org/10.1007/BF01623276] [PMID: 8481591]
[19]
Facts and Statistics. International Osteoporosis Foundation. 2017. Available from: http://www.iofbonehealth.eu/facts-statistics (Accessed on 2020 Nov 1).
[20]
Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996; 348(9041): 1535-41.
[http://dx.doi.org/10.1016/S0140-6736(96)07088-2] [PMID: 8950879]
[21]
Hawley S, Leal J, Delmestri A, et al. Anti-osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and wales: an interrupted time-series analysis. J Bone Miner Res 2016; 31(11): 2008-15.
[http://dx.doi.org/10.1002/jbmr.2882] [PMID: 27377877]
[22]
Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008; (1): CD001155.
[http://dx.doi.org/10.1002/14651858.CD001155.pub2] [PMID: 18253985]
[23]
Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009; 361(8): 756-65.
[http://dx.doi.org/10.1056/NEJMoa0809493] [PMID: 19671655]
[24]
Boonen S, Adachi JD, Man Z, et al. Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab 2011; 96(6): 1727-36.
[http://dx.doi.org/10.1210/jc.2010-2784] [PMID: 21411557]
[25]
Swart KMA, van Vilsteren M, van Hout W, et al. Factors related to intentional non-initiation of bisphosphonate treatment in patients with a high fracture risk in primary care: A qualitative study. BMC Fam Pract 2018; 19(1): 141.
[http://dx.doi.org/10.1186/s12875-018-0828-0] [PMID: 30139341]
[26]
Lindsay BR, Olufade T, Bauer J, Babrowicz J, Hahn R. Patient-reported barriers to osteoporosis therapy. Arch Osteoporos 2016; 11(1): 19.
[http://dx.doi.org/10.1007/s11657-016-0272-5] [PMID: 27129487]
[27]
Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996-2012: An ecological analysis. J Bone Miner Res 2015; 30(12): 2179-87.
[http://dx.doi.org/10.1002/jbmr.2565] [PMID: 26018247]
[28]
Kennel KA, Drake MT. Adverse effects of bisphosphonates: Implications for osteoporosis management. In Mayo Clinic Proceedings 84(7): 632-8.
[29]
Payne KF, Goodson AM, Tahim AS, Rafi I, Brennan PA. Why worry about bisphosphonate-related osteonecrosis of the jaw? A guide to diagnosis, initial management, and referral of patients. Br J Gen Pract 2017; 67(660): 330-1.
[http://dx.doi.org/10.3399/bjgp17X691565] [PMID: 28663433]
[30]
Paskins Z, Crawford-Manning F, Cottrell E, et al. Acceptability of bisphosphonates among patients, clinicians and managers: A systematic review and framework synthesis. BMJ Open 2020; 10(11): e040634.
[http://dx.doi.org/10.1136/bmjopen-2020-040634] [PMID: 33148763]
[31]
Ma S, Goh EL, Jin A, et al. Long-term effects of bisphosphonate therapy: Perforations, microcracks and mechanical properties. Sci Rep 2017; 7: 43399.
[http://dx.doi.org/10.1038/srep43399] [PMID: 28262693]
[32]
Gao Y, Liu X, Gu Y, et al. The effect of bisphosphonates on fracture healing time and changes in bone mass density: A meta-analysis. Front Endocrinol (Lausanne) 2021; 12: 688269.
[http://dx.doi.org/10.3389/fendo.2021.688269] [PMID: 34526966]
[33]
NHFD Group. The national hip fracture database national report. [London]: NHFD 2010. Available from: https://www.nhfd.co.uk/20/hipfractureR.nsf/945b5efcb3f9117580257ebb0069c820/7de8dac5ec3b468980257d4f005188f2/$FILE/NHFD2010Report.pdf (Accessed on 2020 Nov 1).
[34]
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007; 22(3): 465-75.
[http://dx.doi.org/10.1359/jbmr.061113] [PMID: 17144789]
[35]
Cooper C, Mitchell P, Kanis JA. Breaking the fragility fracture cycle. Osteoporos Int 2011; 22(7): 2049-50.
[http://dx.doi.org/10.1007/s00198-011-1643-9] [PMID: 21607806]
[36]
McLellan AR, Wolowacz SE, Zimovetz EA, et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: A cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 2011; 22(7): 2083-98.
[http://dx.doi.org/10.1007/s00198-011-1534-0] [PMID: 21607809]
[37]
Wu CH, Tu ST, Chang YF, et al. Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis. Bone 2018; 111: 92-100.
[http://dx.doi.org/10.1016/j.bone.2018.03.018] [PMID: 29555309]
[38]
Ganda K, Puech M, Chen JS, et al. Models of care for the secondary prevention of osteoporotic fractures: A systematic review and meta-analysis. Osteoporos Int 2013; 24(2): 393-406.
[http://dx.doi.org/10.1007/s00198-012-2090-y] [PMID: 22829395]
[39]
Skelton D, Neil F. An evaluation 2007-2009 [Internet]. [Glasgow]: HealthQWest and Glasgow Caledonian University Published 2010.
[40]
McLellan AR, Gallacher SJ, Fraser M, McQuillian C. The fracture liaison service: Success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 2003; 14(12): 1028-34.
[http://dx.doi.org/10.1007/s00198-003-1507-z] [PMID: 14600804]
[41]
McLellan AR, Reid DM, Forbes K, et al. Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland. [Glasgow]: NHS Quality Improvement Scotland 2004. Available from: http://healthcareimprovementscotland.org/his/idocashx?docid=cf66bcfa-1e75-40e4-97c2-a26bb379b8b3&version=-1 (Accessed on 2020 Nov 1).
[42]
FFFAP Group. Fracture Liaison Service Database Annual report December 2018 Achieving effective service delivery by Key messages – report at a glance. [UK]: Royal College of Physicians 2018. Available from: https://www.fffap.org.uk/fls/flsweb.nsf/FLS-Rep_2018.pdf (Accessed on 2020 Nov 1).
[43]
Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL. Vertebral fractures predict subsequent fractures. Osteoporos Int 1999; 10(3): 214-21.
[http://dx.doi.org/10.1007/s001980050218] [PMID: 10525713]
[44]
Mitchell RM, Jewell P, Javaid MK, McKean D, Ostlere SJ. Reporting of vertebral fragility fractures: Can radiologists help reduce the number of hip fractures? Arch Osteoporos 2017; 12(1): 71.
[http://dx.doi.org/10.1007/s11657-017-0363-y] [PMID: 28785996]

Rights & Permissions Print Cite
Article Metrics
7
© 2024 Bentham Science Publishers | Privacy Policy