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How to break bones and alienate people

Alison Smith, shares her story of how being diagnosed with osteoporosis led to her being involved in a national clinical audit to prevent secondary fractures (Fracture Liaison Service Database).

I, like many, had minimal knowledge of what osteoporosis was before I myself fell and broke bones – in this instance carelessly tripping on a pavement and cracking my ribs. A couple of months later, I slipped backwards on a wet floor resulting in admission to hospital with a suspected punctured lung and further broken ribs. It was through these personal experiences that I discovered the real effect of osteoporosis - a condition that weakens bones – and just how valuable my local Fracture Liaison Service (FLS) was in aiding my recovery.

If, like me before this incident, you don’t know what a FLS is, it 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.

My assessment, diagnosis and prescribed treatment followed the defined pathway. The explanation of that pathway was provided by the FLS nurse. Information and advice was given at all stages so that I had clear expectations of next steps. My progress was monitored, queries were relayed to the consultant and the problems I was experiencing with medication were quickly attended to until I was adhering to a safe treatment plan. Advice and information regarding lifestyle and healthy bones was given together with links to support systems such as the The Royal Osteoporosis Society (ROS).

All patients who have suffered fragility fractures should be able to access, and benefit from, an effective Fracture Liaison Service

Alison Smith

Initially, on diagnosis, with winter approaching and icy pavements increasingly slippery I ‘aged’ significantly, becoming anxious about falls and spinal fractures. I cancelled my gym membership and was over cautious regarding mobility. I was also guilty of not adhering to the treatment. On reflection psychologically, ‘acid’ was probably, for me, not a good name to have attached to a medication, which has such specific and cautious directions to its administration. A timely, monitoring phone call from the FLS Nurse who had determined from my records that I had not continued to pick up my prescriptions, set me back on track together with further discussion regarding the ROS support. 

The nurse’s advice was really important and timely as I was able to search out information regarding lifestyle and particularly exercise and I was soon able to redress the imbalance in my life.

I was fortunate enough to be under the care of a local FLS in my area which closely adheres to the FLS Clinical Standards, measured by the Royal College of Physicians (RCP). I am sure that this has contributed to my confidence, understanding and ability to manage my condition safely without sustaining further fragility fractures. But, I believe passionately this should not be ‘fortune’. All patients who have suffered fragility fractures should be able to access, and benefit from, an effective Fracture Liaison Service provided by CCGs which has been prepared to prioritise prevention of secondary fractures and provide better outcomes for patients.

My local Fracture Liaison Service (FLS) was invaluable in terms of my wellbeing, speed of recovery and ability to live comfortably with osteoporosis.

I have become increasingly involved with the local ROS Support Group, which both the FLS Nurse and Consultant visit regularly with medical updates and question and answer sessions. The trust I have in this FLS, I believe to be fundamental to my psychological approach to living with osteoporosis.

In recognition of the relevance of patient engagement the RCP Falls and Fragility Fractures Audit Programme established a patient panel in Autumn 2018 to ensure that patient and carer perspectives are represented in all aspects of falls and fragility fracture audit programme’s (FFFAP) work.

I hope that by being involved with the ROS nationally and locally, adding a patient perspective to the Fracture Liaison Service Database (FLS-DB) advisory group and contributing to the RCP FFFAP Patient and Carer Panel, I can play a part in developing and improving services for all.