Fracture Liaison Services (FLS): a Review
Keywords:
Osteoporosis; Fragility fractures; Fracture liaison services
Abstract
Fragility fractures, namely fractures from low-energy mechanisms that would not produce fracture in a healthy bone, are most commonly caused by osteoporosis, and constitute a major financial burden worldwide. The effectiveness of systems for the prevention of fragility fractures, also known as fracture liaison services (FLS) has been investigated by numerous programs. The FLS is a coordinated care paradigm where several providers work together to help the patient manage their osteoporosis following a fragility fracture in order to help prevent subsequent fractures. FLS offers a thorough method for not only identifying individuals who are at risk for secondary fracture but also for putting into practice evidence-based therapies to stop further fractures. For the FLS to be successful, doctors, nurses, administration and national healthcare systems must work together toward the common objective of protecting patients aged 50 and older from fragility fractures. This review article discusses the current FLS programs, their pros and cons, and emphasizes on the Greek FLS model.
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References
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8. Chandran M, Tan MZW, Cheen M, Tan SB, Leong M, Lau TC. Secondary prevention of osteoporotic fractures--an “OPTIMAL” model of care from Singapore. Osteoporos Int. 2013 Nov;24(11):2809–17.
9. Dehamchia-Rehailia N, Ursu D, Henry-Desailly I, Fardellone P, Paccou J. Secondary prevention of osteoporotic fractures: evaluation of the Amiens University Hospital’s fracture liaison service between January 2010 and December 2011. Osteoporos Int. 2014 Oct;25(10):2409–16.
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31. Spencer D, Howe G, Manolios N. No more excuses: fracture liaison services work and are cost-effective. Med J Aust. 2012 Apr 2;196(6):384.
32. Solomon DH, Patrick AR, Schousboe J, Losina E. The potential economic benefits of improved postfracture care: a cost-effectiveness analysis of a fracture liaison service in the US health-care system. J Bone Miner Res. 2014 Jul;29(7):1667–74.
33. Bogduk N. No more excuses: fracture liaison services work and are cost-effective. Med J Aust. 2012 Aug 6;197(3):147.
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44. Huntjens KMB, van Geel TACM, van den Bergh JPW, van Helden S, Willems P, Winkens B, et al. Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am. 2014 Feb 19;96(4):e29.
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2. Autier P, Haentjens P, Bentin J, Baillon JM, Grivegnée AR, Closon MC, et al. Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int. 2000;11(5):373–80.
3. 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 Mar;22(3):465–75.
4. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1999 Dec;14(5):821–8.
5. 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 Dec;14(12):1028–34.
6. Ahmed M, Durcan L, O’Beirne J, Quinlan J, Pillay I. Fracture liaison service in a non-regional orthopaedic clinic--a cost-effective service. Ir Med J. 2012 Jan;105(1):24, 26–7.
7. Boudou L, Gerbay B, Chopin F, Ollagnier E, Collet P, Thomas T. Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int. 2011 Jul;22(7):2099–106.
8. Chandran M, Tan MZW, Cheen M, Tan SB, Leong M, Lau TC. Secondary prevention of osteoporotic fractures--an “OPTIMAL” model of care from Singapore. Osteoporos Int. 2013 Nov;24(11):2809–17.
9. Dehamchia-Rehailia N, Ursu D, Henry-Desailly I, Fardellone P, Paccou J. Secondary prevention of osteoporotic fractures: evaluation of the Amiens University Hospital’s fracture liaison service between January 2010 and December 2011. Osteoporos Int. 2014 Oct;25(10):2409–16.
10. Eekman DA, van Helden SH, Huisman AM, Verhaar HJJ, Bultink IEM, Geusens PP, et al. Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporos Int. 2014 Feb;25(2):701–9.
11. Huntjens KMB, van Geel TACM, Blonk MC, Hegeman JH, van der Elst M, Willems P, et al. Implementation of osteoporosis guidelines: a survey of five large fracture liaison services in the Netherlands. Osteoporos Int. 2011;22(7):2129–35.
12. Vaile JH, Sullivan L, Connor D, Bleasel JF. A Year of Fractures: a snapshot analysis of the logistics, problems and outcomes of a hospital-based fracture liaison service. Osteoporos Int. 2013 Oct;24(10):2619–25.
13. Wallace I, Callachand F, Elliott J, Gardiner P. An evaluation of an enhanced fracture liaison service as the optimal model for secondary prevention of osteoporosis. JRSM Short Rep. 2011 Feb 10;2(2):8.
14. Fraser M, McLellan AR. A fracture liaison service for patients with osteoporotic fractures. Prof Nurse. 2004 Jan;19(5):286–90.
15. Mitchell PJ. Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep. 2013 Mar;11(1):52–60.
16. McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, 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 Jul;22(7):2083–98.
17. Makras P, Panagoulia M, Mari A, Rizou S, Lyritis GP. Evaluation of the first fracture liaison service in the Greek healthcare setting. Arch Osteoporos. 2017 Dec;12(1):3.
18. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis : report of a WHO study group [meeting held in Rome from 22 to 25 June 1992] [Internet]. World Health Organization; 1994 [cited 2022 Dec 11]. Available from: https://apps.who.int/iris/handle/10665/39142
19. Schuit SCE, van der Klift M, Weel AE a. M, de Laet CEDH, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004 Jan;34(1):195–202.
20. Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005 Dec;90(5):2787–93.
21. Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, et al. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int. 2008 Oct;19(10):1395–408.
22. Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV, et al. A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos. 2016 Dec;11(1):25.
23. Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, et al. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013 Aug;24(8):2135–52.
24. Murray AW, McQuillan C, Kennon B, Gallacher SJ. Osteoporosis risk assessment and treatment intervention after hip or shoulder fracture. A comparison of two centres in the United Kingdom. Injury. 2005 Sep;36(9):1080–4.
25. Van der Kallen J, Giles M, Cooper K, Gill K, Parker V, Tembo A, et al. A fracture prevention service reduces further fractures two years after incident minimal trauma fracture. Int J Rheum Dis. 2014 Feb;17(2):195–203.
26. Gallacher SJ. Setting up an osteoporosis fracture liaison service: background and potential outcomes. Best Pract Res Clin Rheumatol. 2005 Dec;19(6):1081–94.
27. Langridge CR, McQuillian C, Watson WS, Walker B, Mitchell L, Gallacher SJ. Refracture following fracture liaison service assessment illustrates the requirement for integrated falls and fracture services. Calcif Tissue Int. 2007 Aug;81(2):85–91.
28. Seibel MJ. No more excuses: fracture liaison services work and are cost-effective. Med J Aust [Internet]. 2011 Nov 21 [cited 2022 Dec 2];195(10). Available from: https://www.mja.com.au/journal/2011/195/10/no-more-excuses-fracture-liaison-services-work-and-are-cost-effective
29. Cooper MS, Palmer AJ, Seibel MJ. Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study. Osteoporos Int. 2012 Jan;23(1):97–107.
30. Mitchell PJ. Fracture Liaison Services: the UK experience. Osteoporos Int. 2011 Aug;22 Suppl 3:487–94.
31. Spencer D, Howe G, Manolios N. No more excuses: fracture liaison services work and are cost-effective. Med J Aust. 2012 Apr 2;196(6):384.
32. Solomon DH, Patrick AR, Schousboe J, Losina E. The potential economic benefits of improved postfracture care: a cost-effectiveness analysis of a fracture liaison service in the US health-care system. J Bone Miner Res. 2014 Jul;29(7):1667–74.
33. Bogduk N. No more excuses: fracture liaison services work and are cost-effective. Med J Aust. 2012 Aug 6;197(3):147.
34. Kaufman JD, Bolander ME, Bunta AD, Edwards BJ, Fitzpatrick LA, Simonelli C. Barriers and solutions to osteoporosis care in patients with a hip fracture. J Bone Joint Surg Am. 2003 Sep;85(9):1837–43.
35. Jaglal SB, Hawker G, Bansod V, Salbach NM, Zwarenstein M, Carroll J, et al. A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada. Osteoporos Int. 2009 Feb;20(2):265–74.
36. Bogoch ER, Elliot-Gibson V, Wang RYC, Josse RG. Secondary causes of osteoporosis in fracture patients. J Orthop Trauma. 2012 Sep;26(9):e145-152.
37. Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, et al. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int. 2011 Jul;22(7):2051–65.
38. Tosi LL, Gliklich R, Kannan K, Koval KJ. The American Orthopaedic Association’s “own the bone” initiative to prevent secondary fractures. J Bone Joint Surg Am. 2008 Jan;90(1):163–73.
39. Lee D, Filler B, Twetten M. Enhancing fracture and osteoporosis care: implementing a fracture liaison service can improve outcomes, reduce costs. AAOS Now. 2013 Jan 1;30–1.
40. Miller AN, Lake AF, Emory CL. Establishing a fracture liaison service: an orthopaedic approach. J Bone Joint Surg Am. 2015 Apr 15;97(8):675–81.
41. Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004 Aug;35(2):375–82.
42. Feldstein A, Elmer PJ, Smith DH, Herson M, Orwoll E, Chen C, et al. Electronic medical record reminder improves osteoporosis management after a fracture: a randomized, controlled trial. J Am Geriatr Soc. 2006 Mar;54(3):450–7.
43. Huntjens KMB, Kosar S, van Geel T a. CM, Geusens PP, Willems P, Kessels A, et al. Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture. Osteoporos Int. 2010 Dec;21(12):2075–82.
44. Huntjens KMB, van Geel TACM, van den Bergh JPW, van Helden S, Willems P, Winkens B, et al. Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am. 2014 Feb 19;96(4):e29.
45. van Helden S, Cals J, Kessels F, Brink P, Dinant GJ, Geusens P. Risk of new clinical fractures within 2 years following a fracture. Osteoporos Int. 2006;17(3):348–54.
46. van den Bergh JP, van Geel TA, Geusens PP. Osteoporosis, frailty and fracture: implications for case finding and therapy. Nat Rev Rheumatol. 2012 Jan 17;8(3):163–72.
47. Fuggle NR, Kassim Javaid M, Fujita M, Halbout P, Dawson-Hughes B, Rizzoli R, et al. Fracture Risk Assessment and How to Implement a Fracture Liaison Service. In: Falaschi P, Marsh D, editors. Orthogeriatrics: The Management of Older Patients with Fragility Fractures [Internet]. 2nd ed. Cham (CH): Springer; 2021 [cited 2022 Dec 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK565570/
48. 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.
49. Pandya J, Ganda K, Ridley L, Seibel MJ. Identification of Patients with Osteoporotic Vertebral Fractures via Simple Text Search of Routine Radiology Reports. Calcif Tissue Int. 2019 Aug;105(2):156–60.
50. Vaculík J, Stepan JJ, Dungl P, Majerníček M, Čelko A, Džupa V. Secondary fracture prevention in hip fracture patients requires cooperation from general practitioners. Arch Osteoporos. 2017 Dec 18;12(1):49.
51. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019 Jan 31;1(1):CD012424.
52. Malgo F, Appelman-Dijkstra NM, Termaat MF, van der Heide HJL, Schipper IB, Rabelink TJ, et al. High prevalence of secondary factors for bone fragility in patients with a recent fracture independently of BMD. Arch Osteoporos. 2016;11(1):12.
53. Gallagher JC, Sai A, Templin T, Smith L. Dose response to vitamin D supplementation in postmenopausal women: a randomized trial. Ann Intern Med. 2012 Mar 20;156(6):425–37.
54. Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial. JAMA. 2019 Aug 27;322(8):736–45.
55. Brandrud AS, Nyen B, Hjortdahl P, Sandvik L, Helljesen Haldorsen GS, Bergli M, et al. Domains associated with successful quality improvement in healthcare – a nationwide case study. BMC Health Services Research. 2017 Sep 13;17(1):648.
56. Mitchell PJ, Cooper C, Fujita M, Halbout P, Åkesson K, Costa M, et al. Quality Improvement Initiatives in Fragility Fracture Care and Prevention. Curr Osteoporos Rep. 2019 Dec;17(6):510–20.
57. Makras P, Anastasilakis AD, Antypas G, Chronopoulos E, Kaskani EG, Matsouka A, et al. The 2018 Guidelines for the diagnosis and treatment of osteoporosis in Greece. Arch Osteoporos. 2019 Mar 15;14(1):39.
58. Makras P, Vaiopoulos G, Lyritis GP, Greek National Medicine Agency. 2011 guidelines for the diagnosis and treatment of osteoporosis in Greece. J Musculoskelet Neuronal Interact. 2012 Mar;12(1):38–42.
59. Makras P, Athanasakis K, Boubouchairopoulou N, Rizou S, Anastasilakis AD, Kyriopoulos J, et al. Cost-effective osteoporosis treatment thresholds in Greece. Osteoporos Int. 2015 Jul;26(7):1949–57.
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Published
2023-06-26
Section
Review
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