People with low bone density and a tendency to fall are at risk of a fragility fracture and those who sustain one such fracture are at high risk of another. There are approved treatments for low bone density and interventions to reduce falls risk, but they are not offered to most patients who should be on treatment.
The feasibility study has confirmed that there is a wide variation in secondary fracture prevention in the NHS, and significant divergence from standards of care set out by NICE. There is therefore an urgent need for an audit in this domain. The feasibility study has demonstrated that, in principle, a national FLS-DB should be able to audit important aspects of the management and appropriate follow-up of patients who sustain a fragility fracture. There is still progress to be made to define the expected number of fractures more accurately at GP level; there are unanswered questions relating to case documentation in primary care, in particular those relating to assessment and management of falls risk but also in terms of more accurately identifying index fracture dates.
Fracture liaison services (FLSs) have been introduced to ensure that patients are assessed after fragility fracture and offered secondary prevention. A Fracture Liaison Service Database (FLS-DB) has been proposed to support audit to establish the extent to which this is happening.
This feasibility study was conducted to assess whether an FLS-DB can be developed to meet these objectives. More specifically, the feasibility study was designed to find out whether it is possible to determine:
- an accurate estimate of the incidence of fragility fracture in a locality
- whether patients who have had a fragility fracture can be identified in GP records
- whether patients who are assessed and treated for osteoporosis and falls risk can be identified in GP records
- whether the records of patients’ fragility fractures can be matched across GP records and FLS databases.