Fragility Fracture Prevention—Implementing a Fracture Liaison Service in a High Volume Orthopedic Hospital

Abstract

Fragility fractures pose a serious threat to patient health, quality of life, and healthcare sustainability. In order to reduce their clinical, social, and economic burden, a Fracture Liaison Service (FLS) was introduced in a high volume orthopedic hospital in 2017. The purpose of this retrospective observational study is to describe the FLS protocol, introduce its preliminary outcomes, and provide an early evaluation in light of international guidelines and recommendations. All the performances suggested by the International Osteoporosis Foundation (IOF) are provided under the same institution by which a patient is admitted for surgery. Clinical indicators from patient history and administrative indicators from the hospital database have been used to estimate the spread of fragility fracture prevention and the degree of patient compliance to these programs. The research included 403 patients. Although, almost 1/3 were admitted for the second fragility fracture, only half received anti-osteoporotic treatment before it. The degree of prevention was even lower in the case of patients admitted for the first fragility fracture. The risk of being affected by a secondary fracture was seven times higher when patients did not attend any follow-up or diagnostic exam. In order to identify the main determinants of compliance with FLS and perform a cost-effectiveness analysis on a larger sample, it is fundamental to integrate data from different providers.

Task shifting to enhanced physical therapy in musculoskeletal secondary care. An evidence-based narrative review

“…Redistributing skills between professionals can improve efficiency, but major benefits are likely to come from addressing the problem at the source (i.e. secondary fracture service prevention) [48].…”

Fracture liaison service model: project design and accreditation

“…Such secondary prevention programs can be undertaken within clinical pathways that promote the identification, evaluation, and early treatment of individuals who have presented with a recent major fragility fracture. These programs, which involve a coordinated action of various health care professionals with various specificities, can significantly reduce the risk of further fracture events and may represent, therefore, an important resource for both the individual and the community, and the economic sustainability of the financial system [7,8]. For the fractured femur, once overcome the surgical, medical, peri-operative, and early rehabilitation problems, it is necessary to organize a long-term path for the necessary pharmacological prevention of the refracture together with the maintenance and enhancement of motor activity.…”

“…The fracture liaison service (FLS) model refers to multidisciplinary functional coordination structures generally established within third-level hospital centers. The FLS organized around the fractured femur patient, following the strategy of case-finding, are generally virtual structures, not endowed with its own budget and autonomy, but organized as a bridge between the various hospital units that can take charge of the patient at various levels [8]. They are indispensable models for taking care of the patient with femoral fragility fractures who have recently undergone surgical treatment.…”

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

“…12 Nevertheless, there is a considerable gap in the number of patients with recent fractures who are assessed and treated, with only 10% to 20% of patients worldwide undergoing formal treatment. [13][14][15][16] The American Society for Bone and Mineral Research, the International Osteoporosis Foundation, the European League Against Rheumatism, and the European Federation of National Orthopaedic and Trauma Societies have formulated recommendations for the secondary prevention of fractures, referred to as fracture liaison services (FLS). 14,17,18 FLS is a multidisciplinary functional coordination model that allows patients with fracture to quickly initiate secondary prevention plans for fractures.…”