Identifying characteristics of an effective fracture liaison service: systematic literature review
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Fracture liaison services (FLS) have been demonstrated to improve outcomes following osteoporotic fracture. The aim of this systematic literature review (SLR) was to determine the characteristics of an FLS that lead to improved patient outcomes. We conducted a SLR, including articles published between 2000 and February 2017, using global (Medline, EMBASE, PubMed and Cochrane Library) and local databases. Studies including patients aged ≥ 50 years with osteoporotic fractures enrolled in an FLS were assessed. Information extracted from each article included key person coordinating the FLS (physician, nurse or other healthcare professional), setting (hospital vs community), intensity (single vs multiple), duration (long vs short term), fracture type and gender. A meta-analysis of randomised controlled trials was conducted based on the key person coordinating the FLS. Out of 7236 articles, 57 were considered to be high quality and identified for further analysis. The SLR identified several components which contributed to FLS success, including multidisciplinary involvement, driven by a dedicated case manager, regular assessment and follow-up, multifaceted interventions and patient education. Meta-analytic data confirm the effectiveness of an FLS following an osteoporotic fracture: approximate 27% increase in the likelihood of BMD testing and up to 21% increase in the likelihood of treatment initiation compared with usual care. The balance of evidence indicates that the multifaceted FLS and dedicated coordination are important success factors that contribute to effective FLS interventions which reduce fracture-related morbidity and mortality.
KeywordsFracture liaison service Intervention Osteoporosis
The authors would like to thank Dr. Zhongyun Zhao for facilitating this research and author collaborations.
This work was supported by Amgen Inc. Systematic literature review was conducted by Complete HEOR Solutions LLC and funded by Amgen Inc. Writing and editorial assistance was provided by ApotheCom and funded by Amgen Inc. and Gant from NCKUH (NCKUH-10609007, 10605021).
Compliance with ethical standards
Conflict of interest
Chih-Hsing Wu, Chung-Hwan Chen, Po-Han Chen, Jen-Jia Yang, Po-Chun Chang, Ting-Chun Huang, Yuvraj Sharma, and Ruey-Mo Lin declare that they have no conflict of interest. Shalini Bagga has ownership or partnership in Complete HEOR Solutions LLC. Ding-Cheng Chan receives consulting fees from Amgen, Inc.
For this type of study, formal consent is not required.
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