Bone health

Liaison service gives patients a break from ‘a career’ of fragility fractures


Clinicians are being encouraged to be the champion for a fracture liaison service in their area as part of a call to action on secondary prevention of fragility fractures.

Osteoporosis nurse practitioner Kate Bell told the APLAR-ARA meeting that there was a significant treatment gap following fragility fractures.

There was evidence that only 40% of patients with a fracture were ever told by their doctors that they had osteoporosis and as few as 8% of patients were prescribed anti-resorptive treatment after a fracture.

The consequence was that many patients went on to have an ‘osteoporosis career’ – a series of fragility fractures, for example in the wrist or spine, and culminating in a hip fracture.

Yet a fracture liaison service could systematically identify the patients at risk for second or subsequent fractures and, depending on the model of care, also order appropriate investigations, initiate treatment and follow-up to ensure there was integrated care into the future.

Ms Bell, who coordinates the fracture liaison service at Brisbane’s Princess Alexandra Hospital, said a systematic review and meta-analysis of the literature had shown that the full service models were able to reduce the rates of re-fracture.

And even a more limited model offering just identification and investigations was shown to be cost effective.

Other Australian research had also shown that investment in a fracture liaison service could be a cost-effective strategy to reduce osteoporotic fractures.

And international research had shown that bisphosphonate treatment in the context of fracture liaison services reduced the risk for subsequent fragility fractures and mortality.

Ms Bell said a number of organisations across orthopaedics, geriatrics and osteoporosis had initiated a global call to action in 2018 to prevent fragility fractures .

She said the services operated with reasonably inexpensive overheads with nurses or physiotherapists usually in the coordinating roles.

The main criteria for success were have the skills for case finding, being personable and with good communications skills

“Having a local champion is essential because you need people engaged and to put it on the priority list.”

There was also a strong education role to ensure doctors such as orthopaedic surgeons were aware of the service and the option to refer patients if they did not want to continue managing their osteoporosis themselves

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