August 27, 2013Nyon, Switzerland
An influential report published in the journal 'Osteoporosis International', recommends 13 best practice standards in the implementation of coordinator-based fracture liaison services (FLS). The report, 'Capture the Fracture: A Best Practice Framework and Global Campaign to Break the Fragility Fracture Cycle' (1), has been been shaped by input from leaders of established Fracture Liaison Services throughout the world and endorsed by the International Osteoporosis Foundation.
Coordinator-based FLS centre around a coordinator, often a nurse, who acts as a liaison between the patient, orthopaedist, radiologist and family practitioner. Coordinator-based FLS have been shown to close the treatment gap, and are the optimal way for health care providers to identify and manage people at high risk of secondary fractures.
Addressing the treatment gap:
Fragility fractures due to osteoporosis are a major public health problem, resulting in enormous health care costs, disability, or premature death in older adults. Up to 20% of patients die in the first year following hip fractures, and fewer than half of those who survive are able to regain their previous level of function. A patient who has had one fracture is at double the risk of suffering a second, possibly even more serious, fracture. However, as many as 80% of patients who present to a clinic with a fracture are not investigated for osteoporosis, the disease which is often the underlying cause of the fracture. This leaves the patient exposed to a very high risk of secondary fractures – and a future of pain, disability or possibly premature death.
Thirteen standards for best practice in FLS:
The authors of the 'Capture the Fracture' report provide detailed information on 13 key standards: Patient identification; Patient evaluation; Post fracture assessment timing; Vertebral fracture; Assessment guidelines; Secondary causes of osteoporosis; Falls prevention; Multifaceted health and lifestyle risk-factor assessment; Medication initiation; Medication review; Communication strategy; Long-term Management; Database.
Professor Cyrus Cooper, Chair of the IOF Committee of Scientific Advisors, stated, "If systematically identified and treated, patients who have suffered a first fracture stand a good chance of avoiding future debilitating fractures. Furthermore, for the health care system, fracture prevention results in significant cost savings. We hope that the Capture the Fracture best practice framework will assist clinics worldwide to implement effective FLS systems for secondary fracture prevention."