BOAST - Fracture Liaison Services
Date Published: April 2014
Last Updated: April 2014
Background and justification
Fracture Liaison Services (FLS) provide secondary prevention for fragility fractures (defined as a fracture following a fall from standing height or less). These services systematically and proactively identify patients in secondary and/or primary care who have suffered a fragility fracture and assess the patient’s risk of future fragility fracture in a timely fashion. FLS then provide advice and/or therapy to reduce that risk. There is now good evidence that these services are cost-effective and can result in a reduction in the incidence of fragility fractures in the local population.
All patients aged 50 years or older with a fragility fracture that present to an Emergency Department or fracture clinic or have a fragility fracture, such as pelvic or vertebral compression, that is identified in primary care.
Standards for Practice
- A Fracture Liaison Service should be available to all hospitals that provide definitive fracture care, either as an inpatient or an outpatient e.g. fracture clinic,acute spinal clinic.
- Fracture Liaison Services should be led by a consultant physician or general practitioner with appropriate training and expertise in osteoporosis management.
- Fracture Liaison Services should have systems in place that identify all patients 50 years old and over presenting with a fragility fracture, including vertebral fractures. There must be clear entry criteria into the pathway and this should include patients presenting to, and managed within, primary care.
- All patients presenting with a fragility fracture must be provided with written information giving advice on the nature of fragility fractures, bone health, lifestyle, nutrition and bone protection treatment.
- Patients must be offered a multifactorial bone health assessment within 3 months of the incident fracture.
- Fracture Liaison Services must have a system to identify patients at risk of falls and ability to either assess and recommend treatment(s) or refer rapidly to an appropriate service.
- Fracture Liaison Services must have timely access to DEXA scanning. Patients who need DEXA should be offered a date for scan within 12 weeks of their fracture.
- Fracture Liaison Services should have a linked metabolic bone service that allows patients timely access to expert medical advice when required.
- Fracture Liaison Services should maintain good communication with the patients and their General Practioner who must be informed of all test results and theraputic recommendations.
- Fracture Liaison Services should have a system in place to review patient compliance with treatment.
- Fracture Liaison Services should undertake routine audit and submit data to the National FLS-Database once this is established.
NICE Clinical Guidance CG146. Osteoporosis: assessing the risk of fragility fracture
NICE Technology Appraisal TA161. Secondary prevention of osteoporotic fragility fractures.
NICE Quality Standard QS16. Quality standard for hip fracture