More than 50,000 life-altering fractures could be avoided if preventative services were made available more widely, according to a new report released today from the Royal College of Physicians (RCP).
The Fracture Liaison Service Database: Commissioner's report 2019 shows that there are significantly fewer fracture liaison services (FLSs) available for older patients in some parts of England and Wales than others, with 54,000 preventable life-altering fractures estimated to occur over the course of the next 5 years as a result.
The RCP has written to NHS clinical commissioning groups calling for them to take action to ensure FLSs are available in their local areas.
I implore all CCGs to ensure that fracture liaison services (FLSs) are commissioned in their areas so that millions of older people receive the care they deserve.
An FLS is an NHS service providing effective preventative care for patients who sustain a ‘fragility fracture’ – a fall from a standing height or less that results in a fracture, such as a hip fracture. FLSs investigate and treat patients to reduce the risk of future fractures.
Providing prevention of fragility fractures services costs around £640,000 over 5 years but saves the NHS and social care £2.1 million – a net benefit of £1.46 million.
Dr Kassim Javaid, RCP clinical lead for the Fracture Liaison Service Database, said:
Those suffering broken bones are often the most vulnerable in society and it is unacceptable that such variation exists in service accessibility depending on where in the country they live. Fracture liaison services are proven to reduce the risk of experiencing further fractures, reducing the impact on older patients, and save the NHS millions of pounds. I implore all CCGs to ensure that FLSs are commissioned in their areas so that millions of older people receive the care they deserve.
Osteoporosis and broken bones have a significant effect on the lives of older people, with 42% of older people saying osteoporosis has made them feel more socially isolated. 30% say they find that the amount of money they spend relating to their osteoporosis a financial burden.
There are 58 FLSs in England and Wales that submit data to the Fracture Liaison Service Database. Data is available to access on each individual FLS, including the percentage of patients identified and time taken to receive a follow-up appointment.
A ‘fragility’ fracture is a fracture that occurs as result of normal activities, such as a fall from standing height or less. They are fractures of the large bones, generally vertebrae, neck of femur or wrist.
The Department of Health recommends that all patients who suffer a fragility fracture should have access to a local fracture liaison service for assessment (DH Fracture Prevention services: an economic evaluation. London:DH, 2009) and, if required, receive treatment to strengthen their bones (NICE clinical guideline 146 and NICE TA161, TA204).
About fracture liaison services
Fracture liaison services, commonly known as FLSs, are coordinator-based, secondary fracture prevention services. The services are commissioned to be provided by either primary or secondary care trusts. Anyone over 50 years of age, who may have suffered a fragility fracture, should be referred to an FLS for assessment and possible treatment. One in two women and one in five men break a bone after the age of 50. Despite strong evidence supporting the treatment, in 2013 fewer than one in five patients who experienced a fragility fracture requiring therapy received it within a year (QOF achievement, prevalence and exceptions data 2012/13).
The Royal College of Physicians
The Royal College of Physicians (RCP) plays a leading role in the delivery of high‐quality patient care by setting standards of medical practice and promoting clinical excellence. The RCP provides physicians in over 30 medical specialties with education, training and support throughout their careers. As an independent charity representing over 36,000 fellows and members worldwide, the RCP advises and works with government, patients, allied healthcare professionals and the public to improve health and healthcare.