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Fracture Liaison Service Database: Commissioner's Report 2018

The Fracture Liaison Service Database: Commissioner's Report 2018 contains a summary of the audit’s national key findings and recommendations and results for fracture liaison services (FLSs) by region. It also explains what an FLS is and how FLSs could help clinical commissioning groups (CCGs) to reduce the number and cost of unplanned admissions and to make a significant reduction in morbidity and mortality for older people.

Key recommendations

We recommend that all CCGs find out what secondary fracture prevention services are available in your area.

If you do commission an FLS you should:

  • align the key performance indicators (KPIs) for your FLS(s) with the KPIs that are detailed in this report, to reduce duplication and improve transparency
  • review the FLS’s performance and identify areas for improvement
  • identify your local priorities and how secondary fracture prevention fits within this.

If you do not commission an FLS you should identify and engage with your local clinical champions, and the National Osteoporosis Society (fls@nos.org.uk), to co-develop a business case for commissioning a sustainable and effective FLS to prevent further avoidable fractures for their local patients.

There are an estimated half a million fragility fractures in the UK each year – more than three times the annual number of strokes. NICE-approved medications significantly reduce the risk of the next fracture by 20–70% (depending upon fracture site). This is a substantial reduction in risk.

The estimated number of avoidable fractures every year is in the thousands. If more patients were treated after a fragility fracture, many of these fractures could be avoided. All eligible patients receiving effective secondary fracture prevention would provide a real benefit to people in the UK, with almost 54,000 fractures prevented in the first 5 years.

The solution: fracture liaison services

Any fragility fracture approximately doubles the risk of another fracture, and these fractures are most likely to occur in the following 2 years. This highlights the need for rapid assessment and initiation of anti-osteoporosis medication to those in need.

An FLS aims to reduce the risk of subsequent fractures by systematically identifying, treating and referring all eligible patients aged 50 and over who have suffered a fragility fracture to appropriate services. The FLS is a proven approach, recommended by the Department of Health, for targeting these high-risk groups and improving secondary fracture prevention.

An FLS is a way for CCGs to reduce the number and cost of unplanned admissions and to make a significant reduction in morbidity and mortality for older people.