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Identifying characteristics of an effective fracture liaison service: systematic literature review

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Abstract

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.

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Acknowledgments

The authors would like to thank Dr. Zhongyun Zhao for facilitating this research and author collaborations.

Funding

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).

Author information

Authors and Affiliations

  1. Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan

    C.-H. Wu

  2. Institute of Gerontology, National Cheng Kung University College of Medicine, Tainan, Taiwan

    C.-H. Wu

  3. Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan

    C.-H. Chen

  4. Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    C.-H. Chen

  5. Division of Adult Reconstruction Surgery, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    C.-H. Chen

  6. Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    C.-H. Chen

  7. Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Yunlin, Taiwan

    P.-H. Chen

  8. Department of Internal Medicine, Po Jen General Hospital, Taipei City, Taiwan

    J.-J. Yang

  9. Department of Orthopedics, An Nan Hospital, China Medical University, Tainan, Taiwan

    P.-C. Chang

  10. National Taiwan University Hospital Chu-Tung Branch, Hsinchu, Taiwan

    T.-C. Huang & D.-C. Chan

  11. Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA

    S. Bagga & Y. Sharma

  12. Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan

    R.-M. Lin

  13. Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan

    D.-C. Chan

  14. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    D.-C. Chan

Authors
  1. C.-H. Wu
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  2. C.-H. Chen
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  3. P.-H. Chen
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  4. J.-J. Yang
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  5. P.-C. Chang
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  6. T.-C. Huang
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  7. S. Bagga
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  8. Y. Sharma
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  9. R.-M. Lin
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  10. D.-C. Chan
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Corresponding author

Correspondence to D.-C. Chan.

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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.

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For this type of study, formal consent is not required.

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Wu, CH., Chen, CH., Chen, PH. et al. Identifying characteristics of an effective fracture liaison service: systematic literature review. Osteoporos Int 29, 1023–1047 (2018). https://doi.org/10.1007/s00198-017-4370-z

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  • DOI: https://doi.org/10.1007/s00198-017-4370-z

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