Fragility fractures are sentinel events suggesting underlying osteoporosis, and as such all patients with low-trauma fractures should be considered for further investigation for osteoporosis and, if confirmed, started on osteoporosis medication. Disease burden is amplified by inadequate clinical management around Identification, assessment, and intervention for people who have sustained a MTF, despite proven therapeutic options. Conservative estimates suggest that 60% of patients with osteoporosis are not assessed, diagnosed, or treated for osteoporosis in the primary health care setting. The deficits around clinical management, disconnected care between different health settings, and poor consumer awareness also contribute to the increasing disease burden.
Since the concept of secondary fracture prevention was introduced in the early 1990s, various fracture liaison service (FLS) models have been trialled whereby patients with MTF are identified, investigated, and treated by the FLS or recommendations were made to the general practitioner (GP) for bone fragility management. These models are associated with variable rates of success in secondary fracture prevention. FLSs work through coordination with primary care providers, referral into, or the provision of, outpatient bone health clinics. FLSs have been consistently associated with improved rates of bone mineral density testing (BMD)]; investigations to rule out secondary osteoporosis; documented diagnoses ; evidence-based prescription and osteoporosis medication initiation and better patient engagement leading to increased compliance and persistence with bone-sparing treatments.
FLS interventions have consistently demonstrated cost savings to health care systems through fracture prevention, and cost-effectiveness in terms of quality-adjusted life years (QALYs) gained. Models of care (MoC) have been widely developed to support the translation of evidence-based research into health care practice and health systems. Fracture liaison services (FLSs) with varying models of care are in place to take responsibility for this investigative and treatment process.
This review aims to describe outcomes for patients with osteoporotic fragility fractures managed within various FLS models.