Bone health

Step-by-step guide to starting a fracture liaison service

Thursday, 12 Dec 2019


If you’re thinking of starting or expanding a fracture liaison service at your centre but don’t know where to begin, then a practical toolbox that provides a step-by-step guide can help get you started.

Mr Paul Mitchell of Synthesis Medical in New Zealand has spent the last 20 years working globally to support the implementation of Fracture Liaison Services (FLS). He reminded delegates attending the Amgen FLS forum that the World Health Organisation had designated the next decade as the decade of healthy aging.

“And for a jolly good reason…. UN global population data projections shows that in 2017 there was just shy of a billion people over the age of 60 but by the end of the century this will increase to 3.2 billion people… that’s a pretty massive shift…and if you look at Asia Pacific regions specifically by 2050 there will be 1.3 billion people aged 60 and over and 238 million of those will be age 80 and over,” he noted.

According to Mr Mitchell the data were powerful for framing discussions with policy makers [and funders] around the initiation of secondary prevention fracture services.

“We can say it’s because we want better fracture prevention services but governments often want more… the ‘why’ for them is that we want to keep our older people at home and well and living independently for as long as possible,” he said.

The time is now 

Mr Mitchell told delegates that these data are a stark reminder that we are entering a new demographic phase and this meant there is a need to approach the issue of secondary fracture prevention in a different way.

“If you look at every osteoporosis paper all of us have ever written the first two paragraphs read the same ‘osteoporosis is the most common bone disease affecting 1 in 3 women and 1 in 5 men bla bla bla…’ and that’s important and true. However, sharing this demographic data with policy makers, healthcare professionals and, indeed, members of the general public stimulates a discussion that we need to approach preventive healthcare differently, and with a sense of urgency,” he said.

Mr Mitchell conjectured that while members of the audience had written many calls to action in the medical literature, the time for action is now because closing the care gap in 2050 will be too late.

Getting practical – the FLS toolbox

Mr Mitchell told the audience that the Asia Pacific Bone Academy, supported by Amgen, has an FLS focus group, led by Melbourne endocrinologist Professor Peter Ebeling, that has developed a suite of resources.

“This is so that people who want to start an FLS, or who are at varying stages of implementing one, have all the information they need in the one place,” Mr Mitchell said.

The toolbox has a business plan template that uses global and national evidence that can be tailored to fit the circumstances of individual centres.

“The toolbox also has workshop slides which will help when you meet with your colleagues to work out how to tailor developing an FLS to your institution… I think that’s a really important thing to do at the beginning… this is a multidisciplinary exercise because lots of different people interact with lots of different patients,” Mr Mitchell noted.

The tool box also provided a step-by-step ‘how to’ guide depending on what stage of FLS development an individual centre is at. For example, advice is given on setting up a project team and deciding the scope of the service for centres who are just beginning their journey.

“What I can tell you is that many friends with programmes with hundreds of thousands of patients started with hip fractures and then moved on to patients who were admitted to hospital, then outpatients, and then after they had figured that out they worked out how to deal with vertebral fractures… there’s a logical sequence there and so one of the key things is that if you’re just beginning is don’t get overwhelmed,” Mr Mitchell advised.  “Finally, there’s a benefits calculator [access here] created by Asia Care Group employees in Hong Kong where centres can plug in their individual data to get estimates on projected fracture rates at the local level, and the projected savings if an FLS is implemented,” he added.

For more information on the FLS toolbox email [email protected]

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