Report highlights need to help fracture patients adhere to treatment pathways

A report providing insights on how 180,000 people who experienced a fracture in 2018 were helped to recover has highlighted the need to better support patients as they move from hospital care back to their GP.

The Fracture Liaison Service Database (FLS-DB) report, produced by the Care Quality Improvement Department (CQID) of the Royal College of Physicians, shows that while secondary fracture prevention care has been improving overall, patients diagnosed with or at risk of developing osteoporosis are not being checked-in with post fracture.

The report, which looks at 58,979 patient records across 61 Fracture Liaison Services (FLS) in England and Wales in 2018, found that just 36% of patients being recommended anti-osteoporosis medication were being contacted at 12-16 weeks post fracture, down from 38% in 2017 and 41% in 2016.

“Monitoring patients post fracture has declined for a second year in a row,” says Alison Doyle, our head of operations and clinical practice.

“This is concerning because the best practice model is to find the first fracture and prevent a secondary fracture, by encouraging adherence to treatment in this vulnerable patient group. Today’s report highlights the need for more to be done to improve how care is delivered as the patient moves from hospital to their GP.”

She adds, “We will therefore be supporting the excellent work that our regional teams are already doing to help Fracture Liaison Services (FLS) better engage with their local primary care providers to develop improved pathways and monitoring and ensure patients stay on their prescribed bone-sparing medication.”

To support FLS teams with quality improvement, the charity has developed a continuous quality improvement toolkit, to help drive delivery of best and effective care for people with osteoporosis.

In addition to supporting the breakthrough collaboratives, we also promote excellence in FLS through its annual FLS Champions' Summit, clinical networks, regional events and the biennial Osteoporosis 2020 conference in Liverpool.

Other findings from the report highlight the need to do more to identify difficult to capture vertebral fractures (VF). More than two-thirds of VF are undiagnosed, which has led us to produce clinical guidelines for the effective identification of vertebral fractures.

“Vertebral fractures represent a significant opportunity to improve outcomes in the healthcare system,” says Alison. “Patients with VF are at significant risk of further fragility fractures, such as hip fractures, and multiple VF can lead to serious and debilitating symptoms, disability and early death.

"The more that can be done to put our clinical guidance for the effective identification of vertebral fractures into the place, the more people we can help to manage their pain and symptoms and prevent them from developing further fracture.”

Read the report