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Fracture liaison: A crucial tool in the fight against fragility fracture

  • Paul James Mitchell
    Correspondence
    School of Medicine, The University of Notre Dame Australia, Sydney Campus, 128-140 Broadway, Chippendale, New South Wales 2007, Australia.
    Affiliations
    School of Medicine, University of Notre Dame Australia, Sydney, Australia

    Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK

    Osteoporosis New Zealand, Wellington, New Zealand
    Search for articles by this author

      Highlights

      • Fragility fracture patients are at high risk of sustaining secondary fractures.
      • Safe and effective treatments having been available for almost three decades
      • Most fracture patients worldwide are not treated to prevent secondary fractures.
      • Fracture Liaison Services have been shown to circumvent the care gap.
      • Many free educational resources are available to support implementation of new Fracture Liaison Services.

      Abstract

      Over the course of the first half of the 21st century the age structure of the human population will have undergone dramatic change, leading to what has been described by the Fragility Fracture Network and the International Osteoporosis Foundation as a new demographic era. In the absence of widespread implementation of systematic approaches to chronic disease management, and prevention and treatment of osteoporosis and fragility fractures in particular, fracture rates among older people will increase significantly by mid-century. The purpose of this narrative review is to characterise the current and projected burden of fragility fractures, evaluate current gaps in delivery of best clinical practice, and summarise the literature on the Fracture Liaison Service (FLS) model of care. A definition of FLS is provided, in addition to findings of systematic reviews and associated meta-analyses conducted to assess the clinical and economic benefits of FLS. Initiatives intended to enable benchmarking of the quality of care provided by FLS are reviewed, including the flagship International Osteoporosis Foundation Capture the Fracture® Programme and examples of national clinical standards for FLS from several countries. The emergence of national clinical registries to facilitate benchmarking against clinical standards is also considered. Finally, a precis is provided of several global and regional initiatives that aim to support changes in healthcare policy to provide funding, at scale, to support widespread implementation of FLS.

      Keywords

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