103 Fracture liaison services: fragility fractures and falls prevention in the UK

Abstract

Background: The National Osteoporosis Society aims to ensure that every person aged over 50 who breaks a bone has access to a fracture liaison service (FLS). FLS prevent secondary fractures using dedicated case-finding to identify patients with fragility fractures. Patients are assessed and treated for osteoporosis where necessary, and have an assessment of their falls risk with referral to falls services where appropriate. The source of clinical expertise, leadership and support for FLS is, in many cases, rheumatology. FLS also require expertise in falls risk assessment, and should develop close links with Falls Services to ensure that patients at risk of falls are evaluated, referred for appropriate interventions, and provided with seamless and holistic care. Methods: A gap analysis tool was used to measure to what extent services were providing care to the two standards from the Clinical Standards for Fracture Liaison Services relating to falls. Standard 2 states that a patient's need for a comprehensive falls risk assessment should be evaluated within three months of an incident fracture. Standard 5 states that patients identified as being at increased of falls will be referred for intervention to reduce future risk of falls. Data was collected at 102 sites across the UK between 2015 and 2017. Results: Standard 2: 29% of sites did not offer a falls risk assessment within three months of incident fracture. Standard 5: 28% of sites did not have a system in place to refer patients (who had been identified as being at risk of falls) for intervention to reduce their falls risk. Conclusion: Timely intervention and treatment of fragility fractures is essential to prevent further fractures. Up to 11% of hip fracture patients will sustain another hip fracture, and 20% of female vertebral fracture patients will sustain another vertebral fracture in the first year. Some clinicians, including rheumatologists, who supply the clinical expertise for FLS, have been reluctant to conduct falls risk assessment due to the perception that falls risk assessment places excessive demands on practitioner time, or is simply outside their remit. However, without falls risk assessment as part of the evaluation of future fracture risk, the clinical benefit of the FLS in terms of secondary fractures prevented, will not be fully realised. Where services operate to national clinical standards and deliver collaborative care-planning, future risk of falls is reduced by up to 30%. Gap analysis highlights the need for a significant minority of sites to review their current clinical pathway in respect of falls risk assessment and referral to fully implement the standards and address the challenge of falls-related fragility fractures.