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The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture

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Abstract

Introduction: Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow. Methods: An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. Results: During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service’s osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine. Conclusions: The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.

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Notes

  1. North Glasgow University Hospitals NHS Trust, including Western Infirmary and Royal Infirmary; and the South Glasgow University Hospitals NHS Trust, including Southern General Hospital & Victoria Infirmary.

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Acknowledgements

We would like to acknowledge the advice and assistance of Dr Lois Wehren, University of Maryland, in the preparation of this manuscript.

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Authors and Affiliations

  1. Western Infirmary, Glasgow, UK

    Alastair R. McLellan & Mayrine Fraser

  2. Southern General Hospital, Glasgow, UK

    Stephen J. Gallacher & Carol McQuillian

  3. Division of Cardiovascular Sciences & Medicine, Western Infirmary, Glasgow, G11 6NT, UK

    Alastair R. McLellan

Authors
  1. Alastair R. McLellan
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  2. Stephen J. Gallacher
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  3. Mayrine Fraser
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  4. Carol McQuillian
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Correspondence to Alastair R. McLellan.

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McLellan, A.R., Gallacher, S.J., Fraser, M. et al. The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14, 1028–1034 (2003). https://doi.org/10.1007/s00198-003-1507-z

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  • DOI: https://doi.org/10.1007/s00198-003-1507-z

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