Breaking ground: how Fracture Liaison Services are helping older patients

With over 300,000 fragility fractures every year suffered by individuals over the age of 50, Dr Kassim Javaid explains how Fracture Liaison Services can help prevent broken bones and provide better care for older patients.

One in two women over the age of 50 will break a bone. And once they’ve broken that bone, they instantly become twice as likely to break another.

These are startling figures, but don’t even scratch the surface of the devastating physical, emotional and financial impact broken bones have on older people, their families and the NHS.

With an ageing population and demands on the NHS only growing by the day, Fracture Liaison Services (FLS) are helping to provide better care for patients.

What is an FLS?

An FLS is an NHS service that provides effective secondary fracture prevention for patients who sustain a fragility fracture. Every patient aged over 50 who suffers a fracture needs to be assessed for their risk of osteoporosis and falling.

The cost of a broken bone or osteoporosis is not just physicial: 30% of people find that the amount of money they spend relating to their osteoporosis a financial burden. And 42% of people said their osteoporosis has made them feel socially isolated.

When working well, national coverage with FLS will be expected to prevent 54,000 fractures after 5 years. This will make a signicant dent in the 300,000 fragility fractures suffered every year by patients over the age of 50, and will have a massive impact on patients' lives, their families, as well as the NHS and society.

This all clearly demonstrates why it's so important that older patients get the best possible care through Fracture Liaison Services to stop the life-changing impact poor bone health can have on those most vulnerable in society.

42% of people said their osteoporosis has made them feel socially isolated.

Dr Kassim Javaid, clinical lead for the Falls and Fracture Fragility Audit Programme

Things are improving

This week's new report from the RCP shows a continued rise in the outcomes being delivered for patients by FLS:

  • More patients across England and Wales are being seen by FLS
  • Patients are being seen quicker - 70% of patients are seen by an FLS within 90 days of their sentinel fracture.
  • More patients are receiving anti-osteoporosis medication to reduce their risk of another fracture.

The RCP's Fracture Liaison Service Database (FLS-DB) audit is giving a clear framework for doctors, nurses and allied health professionals to look at how well they are working and provides a plaform for improvement.

We give 11 key performance indicators for services to work towards improving how they work, from monitoring how many patients receive a vital falls assessment to looking at how many are being recommended anti-osteoporosis medication.

But it’s still early days.

There are currently 65 FLS submitting data across England and Wales, but this needs to grow so every patient from every trust aged over 50 years has their data submitted to the FLS-DB so we can check the quality of their care and they don’t slip through the cracks.

70% of patients are seen by an FLS within 90 days of their sentinel fracture.

Dr Kassim Javaid, clinical lead for the Falls and Fracture Fragility Audit Programme

Effective fracture prevention

To provide the fracture prevention care the NHS should deliver, more FLS need to be introduced and FLS need to improve. They need to become more effective, efficient and provide care with excellent patient experience. Effective secondary fracture prevention should become routine, so every eligible patient is tested and treated.

Patients, families and local clinicians will need to work with the National Osteoporosis Society Service delivery team, trusts, clinical commissioning groups, Getting It Right First Time (GIRFT), RightCare and other NHS organisations to deliver this.

There is clearly a long way to go until this is embedded in practice all across England and Wales. But until we get there, the RCP FLS-DB audit is here to guide us.

Dr Kassim Javaid is a consultant rheumatologist and clinical lead for the Falls and Fragility Fracture Audit Programme at the Royal College of Physicians.