Skip to main content

A Year of Fractures: a snapshot analysis of the logistics, problems and outcomes of a hospital-based fracture liaison service

Abstract

Summary

Our fracture liaison service identifies patients with low trauma fractures, determines the need for osteoporosis therapy and instigates therapy if necessary. We describe the tracking and outcome of 768 patients attending our emergency department over 1 year and discuss the problems we encountered and potential solutions.

Introduction

Osteoporotic fractures result in substantial morbidity, mortality and economic cost, and patients sustaining a first fracture are known to be at higher risk of sustaining future fracture. Treatment of at-risk patients has been shown to assist in prevention of future fracture including hip fracture. We established a “First Fracture Project” to identify and treat these patients in 2003.

Methods

We assessed “A Year of Fractures”: the logistics, outcome and problems in tracking patients presenting to our emergency department with a low trauma fracture by our fracture liaison service, over 1 year from July 2008 to June 2009. Patients were tracked by our osteoporosis nurse and offered assessment, and treatment where necessary.

Results

In 1 year, 768 patients aged 50 or over were identified from emergency department records as attending with a low trauma fracture. About 84 % of patients eventually received assessment. Of the162 patients progressing through the entire process, 74 % had osteoporosis treatment planned and/or commenced.

Conclusions

Our fracture liaison service was effective at identifying most low trauma fracture patients at risk of further fracture and providing access to osteoporosis assessment. There were many difficulties: we outline logistic and practical issues in delivering our service and suggest potential improvements.

This is a preview of subscription content, access via your institution.

Fig. 1

Abbreviations

ED:

Emergency department

ON:

Osteoporosis nurse

ON:

Osteoporosis clinic

OD:

Osteoporosis doctor

OP:

Osteoporosis

BMD:

Bone mineral density

FC:

Fracture clinic

RPAH:

Royal Prince Alfred Hospital

FFP:

First Fracture Project: previous cohort reported in 2007

References

  1. Economics A (2001) The burden of brittle bones: costing osteoporosis in Australia. Access Economics, Canberra

    Google Scholar 

  2. Center JR, Bliuc D, Nguyen TV et al (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297(4):387–394

    PubMed  Article  CAS  Google Scholar 

  3. Port L, Center J, Briffa NK et al (2003) Osteoporotic fracture: missed opportunity for prevention. Osteoporosis Int 14:780–784

    Article  Google Scholar 

  4. Marsh D, Akesson K, Beaton DE et al (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22(7):2051–2065

    PubMed  Article  CAS  Google Scholar 

  5. Cooper C, Mitchell P, Kanis JA (2011) Breaking the fragility fracture cycle. Osteoporos Int. doi:10.1007/s00198-011-1643-9

    Google Scholar 

  6. Cooper MS, Palmer AJ, Seibel MJ (2012) Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study. Osteoporos Int 23(1):97–107. doi:10.1007/s00198-011-1802-z

    PubMed  Article  CAS  Google Scholar 

  7. NSW Agency for Clinical Innovation (2011) NSW model of care for osteoporosis refracture prevention. Chatswood: NSW Agency for Clinical Innovation: http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/153543/aci_osteoporotic_refractu.pdf#zoom=100. Accessed 2 Jan 2013

  8. Ganda K, Puech M, Chen JS, Speerin R, Bleasel JF, Center JR, Eisman JA, March L, Seibel MJ (2012) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporosis Int. doi:10.1007/s00198-012-2090-y

    Google Scholar 

  9. Vaile JH, Sullivan L, Bennett C, Bleasel JF (2007) First Fracture Project: addressing the osteoporosis care gap. Internal Medicine Journal 37:717–720

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

We received funding from Merck Sharpe and Dohme to assist in setting up the clinic and analysing the data.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. H. Vaile.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Vaile, J.H., Sullivan, L., Connor, D. et al. A Year of Fractures: a snapshot analysis of the logistics, problems and outcomes of a hospital-based fracture liaison service. Osteoporos Int 24, 2619–2625 (2013). https://doi.org/10.1007/s00198-013-2357-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-013-2357-y

Keywords

  • Fracture liaison services
  • Osteoporosis care gap
  • Osteoporotic fracture
  • Secondary fracture prevention