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Our new clinical standards for fracture liaison services

FLS | Guidelines | ROS

05 Sep 2019

We've launched new clinical standards for fracture liaison services (FLS), giving best practice guidance to improve outcomes for patients with fragility fractures. The launch also coincides with Scotland achieving 100 percent FLS coverage and the 20th anniversary of the world’s first FLS in Glasgow.

Our newly launched Effective Secondary Prevention of Fragility Fractures: Clinical Standards for Fracture Liaison Services gives best practice guidance for all healthcare professionals and commissioners on the care of fragility fractures and secondary prevention of future fractures in patients over 50.

Alison Doyle, our Head of Operations and Clinical Practice, says: “Our new clinical standards set the benchmark to improve patient outcomes, use NHS resources appropriately and save money by preventing future fractures. If your local service is not meeting the six important clinical standards, you’re either commissioning the wrong service, or delivering a service that needs improvement.”

Our new online clinical standards reflect current best practice and embed a strong culture of quality, the 5IQ principle. We believe FLSs should:

  • identify all patients over the age of 50 who have suffered a fragility fracture;
  • investigate to assess bone health and falls risk;
  • inform patients to enable them to understand future fracture risk and what can be done to reduce this;
  • intervene to improve bone health and referring to other specialist services including falls prevention;
  • integrate patient care across primary and secondary care to ensure long-term management including making sure that patients are concordant with their treatment in order to obtain its benefits;
  • all with a strong culture of quality that is inclusive, responsive and responsible to individual patients and the health economy.

We have a fracture liaison service toolkit to help NHS bodies such as clinical commissioning groups, health boards or hospitals set up or improve existing FLS services. The toolkit helps NHS organisations to understand the local impact of these broken bones in terms of numbers and socio-economic costs, providing an evidence-based business case and taking a system-wide approach to falls and fractures prevention, for commissioning. We can also support with the implementation of new FLSs.

NHS Scotland has just become the second country in the world, after New Zealand, with 100 percent FLS provision across all health boards. The last health boards in Scotland to recruit staff to operate a FLS are NHS Fife and NHS Western Isles, who have both been supported by the ROS. The FLS model originated in Scotland with the world’s first FLS opening in Glasgow nearly 20 years ago.

Alison continues: “Fracture liaison services, and the benefits they bring to patients is a Scottish model, born and developed in Scotland. Others saw what was happening in Glasgow and copied the success around the world. We’re proud to have helped services across the country make the case for an FLS, demonstrating savings to be made and drawing up pathways. Congratulations to NHS Scotland for leading the way in the UK. It’s time for other parts of the UK to follow Scotland’s example, particularly NHS England which is lagging behind and doesn’t prioritise this important service.”

Dr Stephen Gallacher, Consultant Physician and Endocrinologist, NHS Greater Glasgow and Clyde, said: “People who suffer a low trauma fracture are twice as likely as the general population to suffer a second fracture. This is the basis of the fracture liaison service. The FLS sees and assesses people who present with a low trauma fracture. This assessment may include a bone density measure and will include an assessment of their personal future fracture risk. Those at highest future fracture risk and osteoporosis will be offered anti-osteoporosis therapy. Appropriate use of this therapy can reduce future fracture risk by around 40 percent.

“The world’s first FLSs were set up in 1999/2000 at former Western Infirmary and Southern General Hospitals in Glasgow by Dr Alastair McLellan and me. FLS is now being rolled out across the world."

In Scotland, there are more than 270,000 people with vertebral fractures due to osteoporosis, of which more than 178,000 are currently undiagnosed. Scotland’s 100 percent FLS coverage is expected to prevent 4,589 broken bones (including 1,925 hip fractures) and save £37.5 m for local health and social care economy over five years.

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