Fracture liaison services: improving outcomes for patients with osteoporosis

Abstract

Fragility fractures are sentinels of osteoporosis, and as such all patients with low-trauma fractures should be considered for further investigation for osteoporosis and, if confirmed, started on osteoporosis medication. Fracture liaison services (FLSs) with varying models of care are in place to take responsibility for this investigative and treatment process. This review aims to describe outcomes for patients with osteoporotic fragility fractures as part of FLSs. The most intensive service that includes identification, assessment and treatment of patients appears to deliver the best outcomes. This FLS model is associated with reduction in re-fracture risk (hazard ratio [HR] 0.18–0.67 over 2–4 years), reduced mortality (HR 0.65 over 2 years), increased assessment of bone mineral density (relative risk [RR] 2–3), increased treatment initiation (RR 1.5–4.25) and adherence to treatment (65%–88% at 1 year) and is cost-effective. In response to this evidence, key organizations and stakeholders have published guidance and framework to ensure that best practice in FLSs is delivered.

Fragility fractures in Europe: burden, management and opportunities

“…A growing body of published evidence suggests [74] that FLSs are a cost-effective care delivery model that has the potential to reduce the risk of refracture, increase the number of high-risk patients being treated and improve adherence to treatment. [71][72][73][74][75][76][77].…”

“…For example, some FLS only identify patients and inform them without taking any further actions whereas other more complete FLS identify, investigate, treat and monitor the patient. In another recent study, the evidence of different FLS model types (A to D) on fracture risk, DXA referrals, and other patient outcomes were reviewed [77]. The most complete FLS model (type A) was associated with reduction in refracture risk (hazard ratio [HR] 0.18-0.67 over 2-4 years), increased assessment of BMD (relative risk [RR] 2-3), increased treatment initiation (RR 1.5-4.25) and adherence to treatment (65-88% at 1 year).…”

An evaluation of Fracture Liaison Services in the detection and management of osteoporotic fragility fractures: A narrative review

“…12,13 They are a significant health concern due to the increased risk of future fractures and an associated increase in morbidity and mortality. 14,15 In this patient group, a previous fracture is thought to double the risk for subsequent fractures, and in the case of vertebral fractures this risk is quadrupled. 4 The risk of vertebral fracture increases exponentially with a greater number of prior vertebral fractures; known as the vertebral fracture cascade.…”

“…13,14 Even when they are detected in hospital, it does not necessarily mean that it will lead on to an assessment of bone health or subsequent treatment. 15 In the clinical setting the asymptomatic nature of vertebral fractures presents a challenge, meaning that they can go untreated and the future fracture risk remains. So how can radiology help?…”

Úr gögnum Hjartaverndar: Nokkur atriði um faraldsfræði og áhættumat beinbrota á Íslandi

“…28 Þetta þjónustuferli hefur nú verið tekið upp á Landspítala undir heitinu "Grípum brotin" eða "Brotakeðjuþjónusta".…”