The most effective way of preventing older people from suffering fragility fractures is a Fracture Liaison Service (FLSs). An FLS can be based in a fracture unit within a hospital, or linked to a number of GP surgeries within primary care.
The hub of each FLS is often a specialist nurse, who is specifically trained to identify and record every patient who has had a fragility fracture. The specialist nurse will also ensure that patients are offered osteoporosis and falls prevention treatment where necessary. A similar model is used to co-ordinate stroke services. The FLS model was pioneered in Glasgow. Other centres of excellence are located across the UK, in places such as Aberystwyth, Belfast, Ipswich and Newcastle.
A Fracture Liaison Service should fit into a comprehensive local falls and fracture prevention service, which spans health and social care.
We want a Fracture Liaison Service linked to every hospital that receives fragility fractures in theUK, to ensure that every fragility fracture patient gets the treatment and care they need.
An audit of falls and fracture services by The Royal College of Physicians and the Healthcare Quality Improvement Partnership (HQIP) was published in March 2009; it found that 31% of NHS and Health and Social Care Trusts in England, Wales and Northern Ireland have the assessment and management of fracture patients co-ordinated by a Fracture Liaison Nurse.
In Scotland, the situation is much better; 78% of the population have access to secondary fracture prevention services through an FLS. A Scottish Government audit conducted in 2011 found that 66% of Community Health and Care Partnerships (CH(C)Ps) provide an FLS.
Glasgow has had a city-wide FLS since 2002, which has operated in parallel a falls prevention service. The FLS was expanded to include the neighbouring Clyde region in 2009. Studies on hip fracture incidence in the Greater Glasgow show that between 1998 and 2008, the number of hip fractures in the area decreased by 7.3% from 1377 to 1276 fractures. In comparison, hospital admissions for hip fracture in those aged 65 and over in Englandhave increased by approximately 2% per year during the years 1998/99 to 2008/09, a total rise of 17%.
These results highlight a significant health inequality between the future fracture risks of those patients who have and have not had their care co-ordinated by an FLS.
However, progress is being made with public policy frameworks in place in England, Northern Ireland, Scotland and Wales to ensure that these services are implemented.
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