Abstract
Fracture Liaison Services (FLS) have been shown to deliver clinically and cost-effective osteoporosis care for patients presenting to hospital with fragility fractures. During the first decade of the new millennium, a consensus emerged in the UK on the need for universal access to FLS. This presentation described constructive interactions between policy makers, professional organizations, patients and their associations, and pharmaceutical manufacturers that led to the incorporation of FLS into national policy and guidance.
Similar content being viewed by others
Notes
NICE is an independent organization responsible for developing clinical guidelines and providing national guidance on promoting good health and preventing and treating ill health.
References
NHS Choices. About the NHS: Structure. Available for download from: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx. Accessed 10 March 2011
Office for National Statistics. Population estimates (2008) UK population approaches 61 million in 2007. Available for download from: http://www.statistics.gov.uk/pdfdir/popest0808.pdf. Accessed 10 March 2011
Skelton D, Neil F (2009) NHS Greater Glasgow and Clyde Strategy for Osteoporosis and Falls Prevention 2006–2010: an evaluation 2007–2009. Health QWest and Glasgow Caledonian University. http://library.nhsggc.org.uk/mediaAssets/OFPS/NHSGGC%20Strategy%20for%20Osteoporosis%20and%20Falls%20Prevention%202006-2010_An%20Evaluation_Skelton%20and%20Neil%202009.pdf. Accessed 10 March 2011
Eastell R, Reid DM, Compston J et al (2001) Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action? Q J Med 94(11):575–597
Elliot-Gibson V, Bogoch ER, Jamal SA et al (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15(10):767–778
Giangregorio L, Papaioannou A, Cranney A et al (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35(5):293–305
British Orthopaedic Association (2003) Blue Book: the care of fragility fracture patients
British Orthopaedic Association (2007) The care of patients with fragility fracture. Available for download from: http://www.fractures.com/pdf/BOA-BGS-Blue-Book.pdf. Accessed 10 March 2011
British Orthopaedic Association, British Geriatrics Society and the Healthcare Quality Improvement Partnership. The National Hip Fracture Database. Visit http://www.nhfd.co.uk/
Gallagher JC, Melton LJ, Riggs BL et al (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res 150:163–171
Port L, Center J, Briffa NK et al (2003) Osteoporotic fracture: missed opportunity for intervention. Osteoporos Int 14(9):780–784
McLellan AR, Reid DM, Forbes K et al (2004) NHS Quality Improvement Scotland. Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland. Available for download from: http://www.nhshealthquality.org/nhsqis/qis_display_findings.jsp?pContentID=2755&p_applic=CCC&pElementID=0&pMenuId=0&p_service=Content.show. Accessed 10 March 2011
Edwards BJ, Bunta AD, Simonelli C et al (2007) Prior fractures are common in patients with subsequent hip fractures. Clin Orthop Relat Res 461:226–230
Brankin E, Mitchell C, Munro R (2005) Closing the osteoporosis management gap in primary care: a secondary prevention of fracture programme. Curr Med Res Opin 21:425–482
World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK (2008) FRAX® WHO Fracture Risk Assessment Tool. Available for download from: http://www.shef.ac.uk/FRAX/tool.jsp. Accessed 10 March 2011
Nevitt MC, Cummings SR, Browner WS et al (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 135:490–499
Hundrup YA, Hoidrup S, Obel EB et al (2004) The validity of self reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register. Scandanavian Journal of Public Health 32:136–143
Ivers RQ, Cumming RG, Mitchell P et al (2002) The accuracy of self-reported fractures in older people. J Clin Epidemiol 55:452–457
McLellan A, Gallacher S, Fraser M et al (2003) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14(12):1028–1034
Gallacher SJ (2005) Setting up an osteoporosis fracture liaison service: background and potential outcomes. Best Pract Res Clin Rheumatol 19(6):1081–1094
National Institute for Health and Clinical Excellence (2004) Falls: the assessment and prevention of falls in older people. Clinical guideline 21. Available for download from: http://www.nice.org.uk/CG21. Accessed 10 March 2011
Langridge CR, McQuillian C, Watson WS et al (2007) Refracture following Fracture Liaison Service assessment illustrates the requirement for integrated falls and fracture services. Calcif Tissue Int 81(2):85–91
Dell R, Greene D, Schelkun SR et al (2008) Osteoporosis disease management: the role of the orthopaedic surgeon. Journal of Bone and Joint Surgery (Am) 90(Suppl 4):188–194
Majumdar SR, Lier DA, Rowe BH et al (2011) Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture. Osteoporosis Int 22(6):1799–1808
Majumdar SR, Lier DA, Beaupre LA et al (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 169(1):25–31
Harrington JT (2006) Dilemmas in providing osteoporosis care for fragility fracture patients. US Musculoskeletal Review—Touch Briefings 2:64–65, http://www.touchbriefings.com/cdps/cditem.cfm?nid=2162&cid=5#Osteoporosis. Accessed 10 March 2011
Chami G, Jeys L, Freudmann M et al (2006) Are osteoporotic fractures being adequately investigated?: A questionnaire of GP & orthopaedic surgeons. BMC Fam Pract 7(1):7
National Osteoporosis Society (2009) Protecting fragile bones: a strategy to reduce the impact of osteoporosis and fragility fractures in Scotland. Available for download from: http://www.nos.org.uk/page.aspx?pid=818. Accessed 11 March 2011
The Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians, London. National Audit of Falls and Bone Health in Older People. 2005–2011. Visit http://www.rcplondon.ac.uk/resources/national-audit-falls-and-bone-health-older-people. Accessed 11 March 2011
Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians, London (2006) National Audit of the Organization of Services for Falls and Bone Health for Older People
The Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians, London (2009) National Audit of the Organization of Services for Falls and Bone Health for Older People. Available for download from: http://www.rcplondon.ac.uk/sites/default/files/national-falls-and-bone-health-public-audit-report-march-2009.pdf. Accessed 11 March 2011
Department of Health in England. Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 21 May 2008: Prevention Speech: Old Age is the New Middle Age. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/MediaCentre/Speeches/DH_085020. Accessed 11 March 2011
Department of Health in England (2009) Falls and fractures: effective interventions in health and social care. Prevention Package for Older People. Available for download from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/documents/digitalasset/dh_109122.pdf. Accessed 11 March 2011
Department of Health in England (2009) Fracture prevention services: an economic evaluation. Prevention Package for Older People. Available for download from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_110099.pdf. Accessed 11 March 2011
Healthcare Quality Improvement Partnership. Older People (2011). Visit http://www.hqip.org.uk/older-people/. Accessed 11 March 2011
British Orthopaedic Association, British Geriatrics Society and the Healthcare Quality Improvement Partnership (2010) The National Hip Fracture Database National Report 2010—Extended version. The National Hip Fracture Database. Available for download from: http://www.nhfd.co.uk/nhfd1.nsf/NHFD_National_Report_Extended_2010.pdf. Accessed 11 March 2011
Department of Health in England (2010) Best Practice Tariffs. Available for download from: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Managingyourorganization/Financeandplanning/NHSFinancialReforms/DH_105080. Accessed 11 March 2011
Jennings LA, Auerbach AD, Maselli J et al (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58(4):650–657
Mitchell PJ, Adekunle F (2010) Fracture Liaison Services Resource Pack: provided as a service to medicine by Novartis. Novartis Pharmaceuticals UK Ltd. Available for download from: http://www.synthesismedical.com/images/Fracture%20Liaison%20Services%20Resource%20Pack%20-%20SDT09000002.pdf. Accessed 11 March 2011
Mitchell PJ, Dolan L, Sahota O et al (2010) The Breaking Point Report. The Patients Association, British Menopause Society, Women’s Health Concern, International Longevity Centre, Amgen and GlaxoSmithKline. Available for download from: http://www.ilcuk.org.uk/record.jsp?type=publication&ID=71. Accessed 11 March 2011
National Osteoporosis Society (2010) Fracture Liaison Services: Our FLS Events. Available for download from: http://www.nos.org.uk/page.aspx?pid=986&srcid=240
The Bone and Joint Decade. BJDonline: Bone and Joint Decade’s Musculoskeletal Portal. Visit http://www.boneandjointdecade.org/. Accessed 11 March 2011
Acknowledgments
The work described in this presentation represents the efforts of numerous colleagues and their respective organizations over the last decade. Major contributions from the following individuals should be highlighted; Dr. Alastair McLellan (Western Infirmary, Glasgow), Dr. Stephen Gallacher (Southern General Hospital, Glasgow), Sister Mayrine Fraser (Western Infirmary, Glasgow), Sister Carol McQuillian (Southern General Hospital, Glasgow), Dr. Eamonn Brankin (Coatbridge, Scotland), Dr. Jonathan Bayly (University of Derby), Dr. Alun Cooper (Crawley, England), Professor David Marsh (British Orthopaedic Association), Dr. Finbarr Martin (British Geriatrics Society), Professor Keith Willett (Oxford University and Department of Health in England), Professor David Oliver (City University and Department of Health in England), Anne Macleod (Department of Health in England), Nye Harries (Department of Health in England), Dr. Colin Currie (NHFD), Dr. Robert Wakeman (NHFD), Maggie Partridge (NHFD), Professor David Reid (University of Aberdeen), Professor Roger Francis (Newcastle University), Professor Opinder Sahota (Nottingham University), Professor Cyrus Cooper (Universities of Oxford and Southampton), Professor Juliet Compston (University of Cambridge), Anne Thurston (NOS), James Cooper (NOS), Juliette Brown (NOS), Dr. Femi Adekunle (Novartis Pharmaceuticals UK Ltd), Emma Gilbert (Amgen), Eddie Kerr (Roche Products Ltd), Mark Waker (London, England), Alan Potter (Stroud, England), and Chris Boulton (Amersham, England).
The author would like to express sincere thanks to Dr. Michele Solloway (Kaiser Permanente Center for Health Research) and Jaimee Kaffka (UAB Continuing Medical Education) for providing logistical support in the preparation of this manuscript.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mitchell, P.J. Fracture Liaison Services: the UK experience. Osteoporos Int 22 (Suppl 3), 487 (2011). https://doi.org/10.1007/s00198-011-1702-2
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00198-011-1702-2