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Breaking the cycle of recurrent fracture: implementing the first fracture liaison service (FLS) in British Columbia, Canada

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Abstract

Summary

Fractures occurring with very little trauma are often caused by osteoporosis and can lead to disability. This study demonstrates that a coordinator working with an orthopaedic team can significantly increase the number of individuals receiving appropriate treatments during their after-fracture care to prevent future fractures from occurring.

Purpose

Well-implemented Fracture Liaison Service (FLS) programs increase appropriate investigation and treatment for osteoporosis after low trauma fracture. This research evaluates the effectiveness of the first FLS program implemented in British Columbia (BC), Canada.

Methods

A controlled before-and-after study was conducted. The intervention was an FLS program implemented at an orthopaedic outpatient clinic at Peace Arch Hospital in BC. Eligible patients were those over the age of 50 years with a low trauma fracture of the hip, pelvis, vertebra, wrist or humerus. A nurse practitioner FLS coordinator identified, investigated and initiated treatment in patients based on their future fracture risk. The primary outcome was the percentage of all patients at high-risk to refracture, who achieved at least one of the following outcomes: (1) started on osteoporosis medication, (2) referred to an osteoporosis consultant or (3) assessed for treatment change if they were already on osteoporosis medication at the time of the fracture. Secondary outcomes included the rate of bone density testing, referral to fall prevention programs and change in health-related quality of life over 6 months.

Results

A total of 195 patients participated in the study (65 in the usual care group, 130 in the FLS group). Average age was 70.5 years (standard deviation 11.5), and 84% of participants were female. In the FLS group, 77.8% of high-risk patients achieved the primary outcome compared with 22.9% in the usual care group.

Conclusion

In BC, the implementation of an FLS program improved investigation and treatment for osteoporosis after low trauma fracture.

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Acknowledgments

The authors would like to acknowledge the efforts of Amandeep Gill, Gabrielle Napoleone and Ashley Tisseur for project coordination; Nancy Parmar (FLS coordinator) for developing local FLS templates, tools and processes; Aven Sidhu for manuscript preparation; Department of Evaluation and Research Services, Fraser Health for statistical support and analysis; and all the team members who participated in the project over the years: Kerstin Gustafson, Ashdin Tavaria, Sarah Metcalfe, Dana Hayward, Liz DaSilva, Jodi Kortje, Anne Davidson, Supna Sandhu, and Jamie Dunwoody.

Funding

This study was supported by the Canadian Institutes of Health Research, Peace Arch Hospital Foundation, and the British Columbia Ministry of Health. Sonia Singh also obtained supplementary funding from Amgen Canada in the form of an unrestricted grant-in-aid for the project.

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Authors and Affiliations

  1. Fraser Health Authority, Surrey, British Columbia, Canada

    Sonia Singh, Valerie MacDonald, Pet-Ming Leung, Kathleen Friesen & Fabio Feldman

  2. Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada

    Sonia Singh & David GT Whitehurst

  3. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Sonia Singh & Vicky Scott

  4. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada

    David GT Whitehurst

  5. Osteoporosis Canada, Toronto, Ontario, Canada

    Larry Funnell

  6. Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada

    Fabio Feldman

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  1. Sonia Singh
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Correspondence to Sonia Singh.

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Conflict of interest

David GT Whitehurst, Larry Funnell, Vicky Scott, Valerie MacDonald, Pet-Ming Leung, Kathleen Friesen, and Fabio Feldman declare they have no conflicts of interest. Sonia Singh discloses Amgen Canada grant -in- aid in support of the FLS project, Amgen Canada one-time only advisory board participation with honorarium in 2016, and Eli Lilly Canada sponsorship for a dinner for Fraser Health orthopaedic surgeons in 2013, as part of the engagement and planning process for this project.

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Singh, S., Whitehurst, D.G., Funnell, L. et al. Breaking the cycle of recurrent fracture: implementing the first fracture liaison service (FLS) in British Columbia, Canada. Arch Osteoporos 14, 116 (2019). https://doi.org/10.1007/s11657-019-0662-6

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