Establishment of nationwide fracture liaison service could dramatically reduce fracture rates in elderly patients

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Ireland’s Fracture Liaison Service Database has published its first national report on fragility bone fractures in Ireland. The report recommends the establishment of fracture liaison services (FLS) in hospitals throughout the country, which could lead to major reductions in the number of fractures suffered by people as they age.

The aim of the FLS is to provide a system for assessing people over 50 years of age who sustain a low-trauma ‘fragility’ fracture, to diagnose osteoporosis and identify those most at risk of future falls and more serious fractures such as those of the hip or spine.

This report analysed secondary prevention of fragility fractures in eight out of the 16 hospitals which currently manage patients presenting with fractures.

Fragility fractures are fractures that occur after simple falls. They are common in people with osteoporosis, a condition that affects over 300,000 thousand people in Ireland. Up to 50% of people who sustain a major fracture (e.g. a hip fracture) would have had a previous non-hip 'warning fracture'.  Most of these patients do not get screened, or treated at that point, for osteoporosis. An assessment of their risk of falling, which might help prevent future fractures, is also not carried out at the time of their initial fracture.

It is estimated that 30,000 non-hip fragility fractures occur annually in Ireland. The treatment of fragility fractures accounts for approximately 2% of the total healthcare spend in Ireland and costs the health service over €400 million per annum.

This first report analysed the treatment received by over 2,000 patients during 2021. The low proportion of patients identified and treated demonstrates that Ireland is a long way from adequately managing these patients, in line with international best practice standards.

Many recent publications in the scientific literature have outlined the benefits that FLS provide, both for patients in reducing their risk of recurrent fractures, and for society as a whole in reducing the costs associated with caring for patients who lose their ability to live independently as a result of these fractures.

Mr Paddy Kenny, Joint National Clinical Lead for RCSI National Clinical Programme for Trauma and Orthopaedic Surgery welcomed this first report, stating: “The development of a Fracture Liaison Services Database is a key enabler in implementing recommendation 15 of the 2018 HSE report, 'A Trauma System for Ireland'.  Having Irish data will facilitate policymakers to plan service delivery more effectively and efficiently into the future. I commend the national clinical leads in promoting the work that this group has completed to date and welcome the recent appointment of eight advanced nurse practitioners for fracture liaison services nationally.”

Professor Frances Dockery, joint clinical lead for the Fracture Liaison Service Database, said: “This report provides a benchmark for future service developments in Ireland.  The lack of investment in a national FLS needs to be addressed as a matter of urgency so that all 16 hospitals that receive trauma patients with fractures in Ireland can establish a fully-staffed FLS, and contribute data to the National FLS Database to monitor the standards of care their patients receive.”

Mr Aaron Glynn, joint clinical lead for the database, said: “Fracture liaison services should be considered an essential ‘secondary prevention’ service, and as such is an enabler in improving patient health and well-being.”

The FLS was established in 2020 by the National Fracture Liaison Services steering committee under the governance of the RCSI National Clinical Programme for Trauma and Orthopaedic Surgery. The Fracture Liaison Services Database is aligned with the International Osteoporosis Federation’s 'Capture the Fracture' initiative which aims to improve access for patients to comprehensive fracture liaison services globally.

You can download a copy of the Irish Fracture Liaison Service Database – First Report here, or a summary of the report here.

Find more information about trauma and orthopaedics at RCSI here.