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Fracture Liaison Services: Promoting Enhanced Bone Health Care

  • Osteoporosis and Metabolic Bone Disease (KG Saag, Section Editor)
  • Published:
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Abstract

The high prevalence of osteoporotic fractures and their major effect on morbidity and mortality emphasizes the critical need to optimize bone health care. Patients presenting with fragility fractures are at high risk of subsequent fracture, but treatment rates have remained low for these patients. Recently developed fracture liaison services have successfully increased osteoporosis treatment, with improved patient outcomes. We review factors contributing to the treatment gap in osteoporosis, the function of fracture liaison services in reducing this gap, and lessons learned from the literature on effective formats, key elements, and suggestions for managing challenges in implementation of a fracture liaison service.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. LeBlanc ES et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med. 2011;171(20):1831–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Haentjens P et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380–90.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brauer CA et al. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573–9.

    Article  PubMed  CAS  Google Scholar 

  4. Boonen S et al. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int. 2004;15(2):87–94.

    Article  PubMed  Google Scholar 

  5. Hall SE et al. Hip fracture outcomes: quality of life and functional status in older adults living in the community. Aust NZ J Med. 2000;30(3):327–32.

    Article  CAS  Google Scholar 

  6. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761–7.

    Article  PubMed  Google Scholar 

  7. Lyles KW et al. Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture. N Engl J Med. 2007;357(18):1799–809.

    Article  PubMed  CAS  Google Scholar 

  8. Beaupre LA et al. Oral bisphosphonates are associated with reduced mortality after hip fracture. Osteoporos Int. 2011;22(3):983–91.

    Article  PubMed  CAS  Google Scholar 

  9. Sambrook PN et al. Oral bisphosphonates are associated with reduced mortality in frail older people: a prospective five-year study. Osteoporos Int. 2011;22(9):2551–6.

    Article  PubMed  CAS  Google Scholar 

  10. Bolland MJ et al. Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab. 2010;95(3):1174–81.

    Article  PubMed  CAS  Google Scholar 

  11. Center JR et al. Osteoporosis medication and reduced mortality risk in elderly women and men. J Clin Endocrinol Metab. 2011;96(4):1006–14.

    Article  PubMed  CAS  Google Scholar 

  12. Colon-Emeric CS et al. Potential mediators of the mortality reduction with zoledronic acid after hip fracture. J Bone Miner Res. 2010;25(1):91–7.

    Article  PubMed  CAS  Google Scholar 

  13. Wolfe F et al. Bisphosphonate use is associated with reduced risk of myocardial infarction in patients with rheumatoid arthritis. J Bone Miner Res. 2013;28(5):984–91.

    Article  PubMed  CAS  Google Scholar 

  14. Heyworth L et al. Comparison of interactive voice response, patient mailing, and mailed registry to encourage screening for osteoporosis: a randomized controlled trial. Osteoporos Int. 2014;25(5):1519–26.

    Article  PubMed  CAS  Google Scholar 

  15. Aizer J et al. Predictors of bone density testing in patients with rheumatoid arthritis. Rheumatol Int. 2009;29(8):897–905.

    Article  PubMed  CAS  Google Scholar 

  16. Center JR et al. RIsk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007;297(4):387–94.

    Article  PubMed  CAS  Google Scholar 

  17. National Committee for Quality Assurance. HEDIS, 2003.

  18. Medicare National Committee for Quality Assurance State of Health Care Quality 2008 Report. HEDIS, 2008.

  19. Inderjeeth CA, Glennon D, Petta A. Study of osteoporosis awareness, investigation and treatment of patients discharged from a tertiary public teaching hospital. Intern Med J. 2006;36(9):547–51.

    Article  PubMed  CAS  Google Scholar 

  20. Solomon DH et al. Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res. 2007;22(11):1808–15.

    Article  PubMed  Google Scholar 

  21. Eisman JA et al. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res. 2012;27(10):2039–46. A review of the rationale for an FLS, and this paper provides a framework and toolkit for systems based implementation of an FLS.

    Article  PubMed  Google Scholar 

  22. McLellan AR et al. The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int. 2003;14(12):1028–34.

    Article  PubMed  Google Scholar 

  23. Wallace I et al. An evaluation of an enhanced fracture liaison service as the optimal model for secondary prevention of osteoporosis. JRSM Short Rep. 2011;2(2):8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chakravarthy J et al. Secondary prevention of fragility fractures by orthopaedic teams in the UK: a national survey. Int J Clin Pract. 2008;62(3):382–7.

    Article  PubMed  CAS  Google Scholar 

  25. Murray AW et al. Osteoporosis risk assessment and treatment intervention after hip or shoulder fracture. A comparison of two centres in the United Kingdom. Injury. 2005;36(9):1080–4.

    Article  PubMed  CAS  Google Scholar 

  26. Majumdar SR et al. Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture. Osteoporos Int. 2011;22:1799–808.

    Article  PubMed  CAS  Google Scholar 

  27. Boudou L et al. Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int. 2011;22(7):2099–106.

    Article  PubMed  CAS  Google Scholar 

  28. Dell R. Fracture prevention in Kaiser Permanente Southern California. Osteoporos Int. 2011;22(3):457–60.

    Article  PubMed  Google Scholar 

  29. Lih A et al. Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int. 2011;22(3):849–58.

    Article  PubMed  CAS  Google Scholar 

  30. 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;23(1):97–107. An investigation of the cost-effectiveness of an FLS, considering a variety of potential scenarios in a 10-year simulation.

    Article  PubMed  CAS  Google Scholar 

  31. McLellan AR 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;22(7):2083–98.

    Article  PubMed  CAS  Google Scholar 

  32. Solomon DH et al. The potential economic benefits of improved postfracture care: a cost-effectiveness analysis of a fracture liaison service in the US healthcare system. J Bone Miner Res. 2014;29(7):1667–74.

    Article  PubMed  Google Scholar 

  33. Coulson I. Co-ordinating an orthopaedic service. Nurs Stand. 1993;7(32):37–40.

    PubMed  CAS  Google Scholar 

  34. Charalambous CP et al. Improving osteoporosis assessment in the fracture clinic. Ann R Coll Surg Engl. 2009;91(7):596–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Gardner MJ et al. Interventions to improve osteoporosis treatment following hip fracture. A prospective randomized trial. J Bone Joint Surg Am. 2005;87(1):3–7.

    Article  PubMed  Google Scholar 

  36. Austin SM, et al. Effect of physician reminders on preventative care: meta-analysis of randomzied clinical trials. Proc Annu Symp Comput Appl Med Care. 1994:121–124.

  37. Lee RH et al. Osteoporosis screening and treatment among veterans with recent fracture after implementation of an electronic consult service. Calcif Tissue Int. 2014;94(6):659–64.

    Article  PubMed  CAS  Google Scholar 

  38. Eekman DA et al. Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporos Int. 2014;25(2):701–9. In addition to patient outcomes, this paper includes rich data on differences between patients who accepted invitations to attend an FLS.

    Article  PubMed  CAS  Google Scholar 

  39. Huntjens KM et al. Implementation of osteoporosis guidelines: a survey of five large fracture liaison services in the Netherlands. Osteoporos Int. 2011;22(7):2129–35.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  40. Inderjeeth CA et al. A multimodal intervention to improve fragility fracture management in patients presenting to emergency departments. MJA. 2010;193:149–53.

    PubMed  Google Scholar 

  41. Premaor MO et al. Obesity and fractures in postmenopausal women. J Bone Miner Res. 2010;25(2):292–7.

    Article  PubMed  Google Scholar 

  42. Ong T et al. A United Kingdom perspective on the relationship between body mass index (BMI) and bone health: a cross sectional analysis of data from the Nottingham Fracture Liaison Service. Bone. 2014;59:207–10.

    Article  PubMed  Google Scholar 

  43. Curtis JR, Silverman SL. Commentary: the five Ws of a Fracture Liaison Service: why, who, what, where, and how? In osteoporosis, we reap what we sow. Curr Osteoporos Rep. 2013;11(4):365–8. This paper describes not only the basics of FLS but also solutions to some challenges encountered in FLS implementation.

    Article  PubMed  Google Scholar 

  44. Osteoporosis-Associated Fracture Implementation Guide 2013. The Joint Commission. http://www.jointcommission.org/assets/1/6/Osteoporosis_Imp_Guide.pdf; accessed 7/11/14.

  45. Oates MK. Invited commentary: fracture follow-up program in an open healthcare system. Curr Osteoporos Rep. 2013;11(4):369–76. This paper relays an elaborate account of FLS implementation in a healthcare system, providing practical details useful for operationalizing an FLS.

    Article  PubMed  CAS  Google Scholar 

  46. Mitchell PJ. Fracture Liaison Services: the UK experience. Osteoporos Int. 2011;22 Suppl 3:487–94.

    Article  PubMed  Google Scholar 

  47. Bunta AD. It is time for everyone to own the bone. Osteoporos Int. 2011;22 Suppl 3:477–82.

    Article  PubMed  Google Scholar 

  48. Akesson K et al. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24(8):2135–52. This paper describes the International Osteoporosis Foundation's “Capture the Fracture” campaign, intended to support world-wide FLS implementation.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  49. Fraser M, McLellan AR. A fracture liaison service for patients with osteoporotic fractures. Prof Nurse (London, England). 2004;19(5):286–90.

    Google Scholar 

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Conflict of Interest

Juliet Aizer reports that she has no conflict of interest. Dr. Aizer received funding in part from the Rheumatology Research Foundation Clinician Scholar Educator Award. Marcy B. Bolster reports the receipt of a research grant from Eli Lilly, outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by the authors.

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Correspondence to Juliet Aizer.

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This article is part of the Topical Collection on Osteoporosis and Metabolic Bone Disease

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Aizer, J., Bolster, M.B. Fracture Liaison Services: Promoting Enhanced Bone Health Care. Curr Rheumatol Rep 16, 455 (2014). https://doi.org/10.1007/s11926-014-0455-2

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