Fracture Liaison Services: the UK experience

Abstract

Fracture Liaison Services (FLS) have been shown to deliver clinically and cost-effective osteoporosis care for patients presenting to hospital with fragility fractures. During the first decade of the new millennium, a consensus emerged in the UK on the need for universal access to FLS. This presentation described constructive interactions between policy makers, professional organizations, patients and their associations, and pharmaceutical manufacturers that led to the incorporation of FLS into national policy and guidance.

Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England

“…A review of the Glasgow Osteoporosis and Falls Strategy reported that hip fracture rates in the city had reduced by 7.3% over the decade, compared with a 17% increase in fracture rates for the entire population of England over the same period. 19,24 These findings are consistent with observational data from the USA by Dell, who reported a 37.2% reduction in hip fracture rates. 25 However, the strongest evidence on effectiveness has recently been provided by an Australian study that was designed as a prospective observational trial with a concurrent control group in which, compared with standard care, targeted identification and management significantly reduced the risk of refracture by > 80%.…”

“…A fracture liaison service (FLS) is the recommended model proposed by the Department of Health to organise secondary fracture prevention services 1 in a 'one-stop shop' setting delivered by a nurse specialist supported by a lead clinician ('champion') in osteoporosis. 19 However, currently only 30% of hospitals in England have established a FLS. 17 A single model incorporating all components of secondary fracture prevention has not been mandated.…”

“…10 This co-ordinated, multidisciplinary approach to patient care is known as a FLS. 19 FLSs have now been introduced internationally. 35,36 In the UK, the Department of Health has proposed a model of best practice which is delivered by a nurse specialist supported by a lead clinician ('champion') in osteoporosis.…”

“…A number of participants referred here to research conducted on the Glasgow FLS that showed the service contributed to a significant reduction in hip fractures within the city, compared with substantial rise across England. 19 To address the perception of osteoporosis as a low national priority, two clinicians thought that it would be useful to try to align the aims of the service with national priorities such as dementia. 52 Quotes on the best ways of making a business case for a FLS are given below [quotations reproduced with permission from Drew S, Gooberman-Hill R, Farmer A, Graham L, Javaid MK, Cooper C, et al You can use other [services as] comparators and the USA seems to be quite a good thing to beat doctors with at the moment so if you look at outcome in the best centres compared to the average centres, which is quite a good .…”

176. Impact of Hip Fracture on Hospital Care Costs: A Population Based Study

“…Such data would aid decision makers implement policy decisions at a local and national level. A potential costeffective approach is through the implementation of coordinated approaches to fracture prevention such as fracture liaison services (FLS) [23,24]. The Glasgow Fracture Liaison Service [25] reported that for every 1000 patients with a fragility fracture assessed by FLS, 18 fragility fractures (including 11 hip fractures) were prevented.…”