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

2019 ◽  
Vol 16 (24) ◽  
pp. 4902
Author(s):  
Pennestrì ◽  
Corbetta ◽  
Favero ◽  
Banfi
Keyword(s):  
Fragility Fracture ◽  
Fragility Fractures ◽  
High Volume ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Clinical Indicators ◽  
Secondary Fracture ◽  
Early Evaluation ◽  
Orthopedic Hospital ◽  
Fracture Liaison

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.

Systematic approaches to fragility fracture prevention

2014 ◽  
Vol 23 (01) ◽  
pp. 39-44
Author(s):  
D. B. Lee ◽  
P. J. Mitchell
Keyword(s):  
Fragility Fracture ◽  
National Policy ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
The United States ◽  
Fracture Liaison Service ◽  
Reimbursement Mechanisms ◽  
Future Fracture ◽  
National Coalition ◽  
Fracture Liaison

SummaryIndividuals who have suffered fractures caused by osteoporosis – also known as fragility fractures – are the most readily identifiable group at high risk of suffering future fractures. Globally, the majority of these individuals do not receive the secondary preventive care that they need. The Fracture Liaison Service model (FLS) has been developed to ensure that fragility fracture patients are reliably identified, investigated for future fracture and falls risk, and initiated on treatment in accordance with national clinical guidelines. FLS have been successfully established in Asia, Europe, Latin America, North America and Oceania, and their widespread implementation is endorsed by leading national and international osteoporosis organisations. Multi-sector coalitions have expedited inclusion of FLS into national policy and reimbursement mechanisms. The largest national coalition, the National Bone Health Alliance (NBHA) in the United States, provides an exemplar of achieving participation and consensus across sectors. Initiatives developed by NBHA could serve to inform activities of new and emerging coalitions in other countries.

scholarly journals Evaluation of minimal fracture liaison service resource: costs and survival in secondary fracture prevention—a prospective one-year study in South-Finland

2021 ◽  
Author(s):  
P. Lüthje ◽  
I. Nurmi-Lüthje ◽  
N. Tavast ◽  
A. Villikka ◽  
M. Kataja
Keyword(s):  
Secondary Prevention ◽  
Excess Mortality ◽  
Assessment Tool ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Low Energy ◽  
Secondary Fracture ◽  
Dxa Scans ◽  
Fracture Liaison

Abstract Background Fracture liaison service (FLS) is a secondary prevention model for identification of patients at risk for fragility fractures. Aims This study was conducted to evaluate the number and costs of secondary prevention of low-energy fractures in the city of Kouvola in Finland. Methods Women aged ≥ 45 years and men ≥ 60 years treated in the emergency department with a low-energy fracture were identified. Laboratory testing, BMI, and DXA scans were performed. Fracture Risk Assessment Tool was used. The direct FLS costs were calculated. Survival was analyzed using univariate and multivariate analysis and the life-table method. Results 525 patients with 570 fractures were identified. The mean age of women was 73.8 years and of men 75.9 years. Most patients sustained wrist (31%), hip (21%) or proximal humerus (12%) fractures. 41.5% of the patients had osteoporosis according to DXA scans. 62% of patients used calcium and vitamin D daily and 38% started anti-osteoporotic medication. Protective factors for survival were: age < 80 years, female sex, and S-25OHD concentration of 50–119 nmol/L. Excess mortality was highest among patients with a fracture of the femur. The total annual direct costs of FLS were 1.3% of the costs of all fractures. Discussion Many low-energy fracture types were associated with excess mortality. The use of anti-osteoporotic medication was not optimal. Conclusions FLS increased the catchment of low-energy fracture patients and was inexpensive. However, identification, evaluation and post-fracture assessment of patients should be expedited. Rehabilitation of hip fracture patients needs to be improved.

scholarly journals Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laurna Bullock ◽  
Fay Crawford-Manning ◽  
Elizabeth Cottrell ◽  
Jane Fleming ◽  
Sarah Leyland ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Evidence Synthesis ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Delphi Survey ◽  
Shared Decision ◽  
Secondary Fracture ◽  
Drug Treatments ◽  
Fracture Liaison

Abstract Summary Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. Purpose The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the ‘model Fracture Liaison Service (FLS) consultation’ within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. Methods A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was ‘essential’ and percentage agreement calculated; the study team subsequently determined the threshold for essential content. Results Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. Conclusions This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.

scholarly journals Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael Toal ◽  
Connor McLoughlin ◽  
Nicole Pierce ◽  
Julie Moss ◽  
Sarah English ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Bone Density ◽  
Vertebral Fractures ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Radiology Department ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Prevention Services ◽  
Fracture Liaison

Abstract Summary We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. Purpose Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). Methods We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. Results Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology ‘fracture’ increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. Conclusions Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.

scholarly journals Does Fracture Liaison Service Improves Fracture Risk Assessment among Patients with Fragility Fractures? A Systematic Review

2021 ◽  
Author(s):  
Anum Sadruddin Pidani ◽  
Shahryar Noordin ◽  
Joanna Sale
Keyword(s):  
Systematic Review ◽  
Risk Assessment ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Literature Search ◽  
Fragility Fractures ◽  
Fracture Liaison Service ◽  
Fracture Risk Assessment ◽  
Fracture Liaison

Abstract Background: The fragility fractures can cause substantial pain, disability, reduced quality of life and mortality. The probability of sustaining subsequent fractures increases up to five times after an initial fragility fracture. The Fracture Liaison Service is a coordinated model of care that aims to bridge the post-fracture care gap by improving subsequent fracture risk assessment and post-fracture management. However, there are very few studies that included fracture risk assessment as a significant outcome of an FLS program. This systematic review aims to evaluate the available evidence on the effect of FLS in improving fracture risk assessment among fragility fracture patients Method: A systematic literature search will be carried out on the major electronic databases including PubMed, Embase, CINAHL Plus, and Cochrane to identify the outcomes of Fracture Liaison Service. The literature search will not be restricted to the context and year of publication. Two researchers will independently conduct the databases search. We will pilot the search strategy to ensure sufficient sensitivity and specificity. The JBI critical appraisal tools will be used to assess methodological quality of all the included studies. Discussion: This review will highlight an urgent need for more studies from different geographical areas to determine best practices for implementing fracture risk assessment globally and guiding clinical decision making for osteoporosis management. The findings of this systematic review will highlight the importance of including fracture risk assessment as a significant parameter to evaluate FLS programs implemented across the globe. Conclusion: This systematic review will provide more information about fracture risk assessments and its reporting. It will also highlight the variations in the methods of performing a fracture risk assessment with and without BMD testing and the impact of the FLS program in improving fracture risk assessment.

scholarly journals A New Fracture Liaison Service Design Using a Mobile Application and Medical Artificial Intelligence (Preprint)

2018 ◽  
Author(s):  
Sung Woo Kim ◽  
Young Jun Won
Keyword(s):  
Mobile Application ◽  
Osteoporotic Fractures ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Open Policy ◽  
Android Os ◽  
Secondary Fractures ◽  
Fracture Liaison

BACKGROUND While the clinical design of a Fracture Liaison Service(FLS) has been used as a localized healthcare service in a previous study, thus far there has not been an international mobile application, such as a FLS using smart phones. OBJECTIVE The goal of our study is to improve the prevention of secondary fractures using a Mobile FLS Application. METHODS We have developed a Fracture Liaison Service as an Android-OS application and released this service as a secondary fracture prevention program for osteoporotic fracture patients. RESULTS We have released the final version of the FLS mobile application in Google’s PlayStore. The new model of the FLS mobile application can be practically commercialized, and the effective second-order fracture prevention system is based on an open policy platform. CONCLUSIONS We hope to contribute to the prevention and management of osteoporotic fractures and osteoporosis worldwide via this FLS mobile application. In the future, an intelligent personal FLS is definitely possible, by applying a Medical AI based on a huge DB.

scholarly journals 89 Poor Attendance for DXA in Older People with A Low Trauma Fragility Fracture: A 6 Year Data Analysis of the Nottingham Fracture Liaison Service

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i28-i29
Author(s):  
H Desai ◽  
O Hershkovich ◽  
T Ong ◽  
L Marshall ◽  
O Sahota
Keyword(s):  
High Risk ◽  
Fragility Fracture ◽  
Fragility Fractures ◽  
Fracture Liaison Service ◽  
Models Of Care ◽  
University Hospitals ◽  
Department Of Health ◽  
Patients At Risk ◽  
Risk Patients ◽  
Fracture Liaison

Abstract Introduction Hip Fractures are common and result in significant patient morbidity and increased mortality. Up to 40% of these patients have sustained a previous low-trauma fracture. The Department of Health advises that patients presenting with fragility fracture should have access to ‘Fracture Liaison Services (FLS)’. These are models of care which systematically identify patients at risk, assess bone health, treat patients (if needed) and follow patients up to support medication adherence. Methods Demographics of FLS patients between January 2012 and December 2017 was obtained retrospectively from the Nottingham University Hospitals FLS database. We examined DNA rates and further characteristics of these types of patients. Deprivation scores were deprived using the English indices of deprivation 2015 (1–Most deprived; 5-Least deprived). The 2016 cohort of patients were followed-up till January 2019 to assess for re-fractures. Results 6528 high-risk patients were identified and referred to DXA. Mean (SD) age was 68±10.5 years [Females=5302 (81%)]. 1386 patients (21%) did not attend. High prevalence of non-attendance was in females [1032 patients (74%)] and the most deprived individuals [398 patients (29%)]. Females from the most deprived areas had the highest DNA rate [287 patients (29%)]. All eligible patients &gt;75 years old were referred (n=1542 (100%), [Females=1284 (83%), non-attendance=473 (31%), non-attendance in females=390 (82%), highly deprived females=96 (25%)]. 826 patients were referred in 2016. Median follow-up time was 2.46 years (IQR 0.16–3.00 years). 52 patients (7%) re-fractured. 17 patients (33%) DNA their previous DXA scan [Females=12 patients (71%)]. Conclusions Nottingham FLS have identified patients with fragility fractures that are high-risk for further fractures. Despite a dedicated FLS there is a DNA of 21%. Many patients that DNA are generally considered as having a high-risk of further fractures; females, older age and more deprived. Further studies are needed to explore why patients do not attend for bone density scanning.

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