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A national approach to reducing fragility fractures
In the latest in the series of blogs from the Musculoskeletal Programme within the Long Term Conditions Team, Henry Mace, from the National Osteoporosis Society, discusses Fracture Liaison Services and their upcoming webinar with NHS England:
The National Osteoporosis Society is the only UK-wide charity dedicated to improving the prevention, diagnosis and treatment of osteoporosis and fragility fractures across the UK.
Osteoporosis is a silent condition yet the fractures that occur as a result of fragile bones are anything but silent for the thousands of people a year that are affected.
Research has shown that one-in-five women, who have broken a bone, break three or more bones before being diagnosed.
It was this gap in care that pushed us to set up a partnership with the NHS to offer support, guidance and expertise to help establish Fracture Liaison Services (FLS) that identify patients at risk of osteoporosis from their first fracture.
Often people break a bone, are seen by A&E then go back to their normal lives. Our partnership means that nurses in an FLS have access to fracture data from their locality, spotting those who have broken a bone and are also at risk of osteoporosis because of age or lifestyle factors, and bring them into the system so they can be scanned and treated if appropriate.
But it’s not just about broken bones.
One month after suffering a hip fracture, one-in-three people will have died and only half will have returned home. Half of all hip fractures happen to people who have previously fractured. By identifying patients in a consistent, systematic way through an FLS, it is estimated that up to 25% of hip fractures – about 20,000 a year – could be prevented.
The Charity took a series of steps. We first set up an FLS Implementation Group to work in collaboration with healthcare professionals, patients, commissioners, professional organisations and the NOS, to improve access to and quality of FLSs.
We then developed a range of resources. These included:
- Clinical standards for FLS; endorsed by professional organisations including Royal College of Physicians and aligned to NHS England.
- FLS Implementation Toolkit; supporting clinicians and commissioners to develop a business case for an FLS, including an FLS benefits calculator to demonstrate the financial benefits of setting up the service in terms of cost savings and fractures spared.
- Training programme for Fracture Prevention Practitioners; providing knowledge and accreditation for clinicians working in FLS.
- Peer review of osteoporosis and metabolic bone services; assessing clinical care against agreed standards.
The Charity has employed a Service Delivery Team with specialist clinical and commissioning experience to offer tailored guidance in using these resources. In addition, there is advice on the most appropriate outcome measures and performance indicators, as well as on effective data collection for analysis and impact reporting.
The Service Delivery Team has worked closely with NHS clinicians and local CCGs to see the development of nine new FLS in England since January 2015; this covers an additional 2.77million people who are now provided for by an FLS. These new services will prevent 1,020 hip fractures and save the NHS £17.3million over the next five years.
Currently the Service Delivery Team is working with around 160 sites across the UK to support them in implementing an FLS.
As a member of the MSK Clinical Network, the National Osteoporosis Society will be delivering a webinar in collaboration with NHSE to highlight the clinical and cost effectiveness of FLSs across the UK. This will take place on Thursday 21 July at 12 noon. Register for the webinar here.