Fracture Liaison Service
Overview, Importance, and Impact
Fracture Liaison Services (FLS) are specialised healthcare programs designed to address a critical gap in osteoporosis and fragility fracture care. As the population ages, the burden of osteoporosis-related fractures is growing, placing significant strain on healthcare systems.
Over 500,000 fragility fractures occur annually in the UK, costing the NHS £5.25 billion, a figure projected to rise by 30% by 2030. Despite available treatments, 50% of women over 50 do not receive appropriate post-fracture care. By systematically identifying and managing at-risk patients, FLS can reduce these fractures by up to 25%, preventing 20,000 hip fractures annually.
As a proven, cost-effective solution, expanding FLS coverage is essential for improving patient care and alleviating the burden on the National Health Service.
In this article, we will explore the structure and purpose of FLS, its impact on patient outcomes, and the challenges it faces in the UK. We will also discuss the steps that can be taken to improve and expand FLS to ensure that all patients have access to this critical service.
How Fracture Liaison Service Works
Fracture Liaison Services (FLS) serve as a systematic approach to managing fragility fractures, primarily in patients over the age of 50. The core function of FLS is to proactively identify individuals who have experienced a fragility fracture and are at risk of further fractures. Typically led by a dedicated coordinator, often a specialist nurse, FLS integrates multidisciplinary teams including orthopaedics, radiology, primary care, and geriatrics.
1. Identification
FLS begins by identifying patients who have suffered a fragility fracture. This can occur through hospital admissions, outpatient clinics, radiology reports, or GP referrals.
2. Assessment
Once identified, patients undergo a comprehensive bone health assessment. This includes evaluating bone density (often via DXA scans), assessing the risk of future fractures, and investigating potential underlying causes such as osteoporosis.
3. Patient Education
FLS provides information to patients to help them understand their fracture risk and the steps they can take to reduce it. This involves lifestyle advice, dietary recommendations, and information on fall prevention.
4. Intervention
Based on the assessment, FLS recommends appropriate interventions, such as prescribing osteoporosis medications, advising on lifestyle and dietary changes, making referrals to relevant specialists, and providing regular follow-up care to monitor treatment adherence and adjust care plans.
5. Integration with Primary and Secondary Care
FLS ensures long-term management of the patient’s condition by coordinating care between primary and secondary services, ensuring that patients adhere to treatment plans and receive ongoing support.
Importance of Fracture Liaison Services
Reduction in Fracture Recurrence
FLS significantly reduces the risk of subsequent fractures. Individuals are five times more likely to suffer another fracture within two years after the first.
By systematically identifying and treating these patients, FLS can prevent up to 25% of hip fractures, potentially avoiding 20,000 cases annually.
Cost-effectiveness
Investing in FLS offers a high return on investment, saving the NHS approximately £3.28 for every £1 spent. The total annual healthcare cost of fragility fractures in the UK is £5.25 billion, projected to rise to £6.83 billion by 2030. Implementing FLS more widely could reduce these costs by preventing thousands of fractures and related hospitalizations, saving millions of pounds annually.
Improved Patient Outcomes
FLS enhances patient outcomes by improving bone health, reducing future fracture risk, and supporting adherence to treatment. Effective FLS programs reduce both the physical and emotional toll of repeated fractures, leading to better long-term health and quality of life for patients. With over 50% of women over 50 in the UK not receiving appropriate post-fracture care, FLS can bridge this gap, ensuring timely interventions and support.
Current Challenges Faced by FLSs in the UK
Despite the proven benefits of Fracture Liaison Services (FLS), there are several challenges hindering their effectiveness and expansion in the UK.
– Inconsistent Service Availability and Quality
One of the most pressing issues facing FLS is the uneven distribution of services across the UK. The “postcode lottery” results in significant disparities in service availability and quality. In some regions, FLS are well-established and accessible, while in others, they are either non-existent or significantly under-resourced.
According to the Royal Osteoporosis Society, due to this issue, in 2024/25 we’ll see:
- 10,000 preventable fractures
- 4,200 preventable hip fractures that will kill 1,400 people within a year
- £39m of wasted costs in the NHS and social care fixing fractures which could have been prevented
- 105,000 bed days unnecessarily taken up in the NHS
- 650,000 sick days that could have been prevented by FLS
Even where FLS are available, the quality and comprehensiveness of services can vary widely. This variability can lead to inconsistent patient outcomes, with some patients receiving timely, comprehensive care while others may face delays or suboptimal treatment.
– Resource Constraints: Funding, Staffing, and Infrastructure Issues
With competing demands for healthcare resources, preventative services like FLS often struggle to secure the necessary financial support. Additionally, demonstrating the value of FLS to stakeholders can be challenging, particularly in a fragmented approach to fracture management. The benefits of FLS, such as reduced fracture rates and associated costs, may not always be immediately apparent.
Besides funding, effective FLS requires a coordinated approach involving various healthcare professionals, including nurses, specialists, and GPs. Assembling and maintaining these multidisciplinary teams can be challenging, particularly in areas with limited resources.
– Need for Better Monitoring and Auditing Processes
Effective monitoring and auditing are crucial for demonstrating the success of FLS programs and justifying further investment. However, systematic and comprehensive data collection is often lacking, making it difficult to measure and communicate the true value of FLS.
These challenges stem largely from the absence of unified national leadership and strategic direction for FLS implementation. Without a cohesive strategy, the expansion and standardization of FLS services across different regions can be inconsistent and inefficient.
The good news is that there are activities led by the Royal Osteoporosis Society, medical colleges, charities, unions and companies to increase awareness, secure funding, improve service quality, and ultimately achieve 100% FLS coverage across the UK to ensure equal access to vital osteoporosis treatment and care for all patients.
Red Star FLS: A Modern Solution
Red Star’s Fracture Liaison Service offers a transformative solution to the challenges currently faced by FLS in the UK. By automating and streamlining clinical processes, Red Star addresses key issues such as inconsistent service quality and resource constraints. The system enhances service capacity and efficiency with features like a unified dashboard for key clinical information, automated scheduling, and real-time reporting against performance indicators.
This results in a 55% reduction in case processing time and a 100% elimination of waiting lists, significantly speeding up fracture identification, referral for DEXA scans, and the creation of care plans. By removing manual case finding and integrating modern cloud-based technology, Red Star improves fracture detection rates and ensures timely, comprehensive care for all patients, directly addressing the current disparities and resource challenges in FLS provision.