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Fracture liaison services: improving outcomes for patients with osteoporosis

Authors Walters S, Khan T, Ong T, Sahota O

Received 15 October 2016

Accepted for publication 3 December 2016

Published 10 January 2017 Volume 2017:12 Pages 117—127

DOI https://doi.org/10.2147/CIA.S85551

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker


Samuel Walters,1 Tanvir Khan,2 Terence Ong,3,4 Opinder Sahota3

1East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, 2Department of Orthopaedics, Trauma and Sports Medicine, University of Nottingham, 3Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, 4Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK

Abstract: Fragility fractures are sentinels of osteoporosis, and as such all patients with low-trauma fractures should be considered for further investigation for osteoporosis and, if confirmed, started on osteoporosis medication. Fracture liaison services (FLSs) with varying models of care are in place to take responsibility for this investigative and treatment process. This review aims to describe outcomes for patients with osteoporotic fragility fractures as part of FLSs. The most intensive service that includes identification, assessment and treatment of patients appears to deliver the best outcomes. This FLS model is associated with reduction in re-fracture risk (hazard ratio [HR] 0.18–0.67 over 2–4 years), reduced mortality (HR 0.65 over 2 years), increased assessment of bone mineral density (relative risk [RR] 2–3), increased treatment initiation (RR 1.5–4.25) and adherence to treatment (65%–88% at 1 year) and is cost-effective. In response to this evidence, key organizations and stakeholders have published guidance and framework to ensure that best practice in FLSs is delivered.

Keywords: fracture liaison service, fractures, fall, osteoporosis, aged

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