Preventing future broken bones

Fracture Liaison Service's (FLS) are a proven way of preventing people from future breaks as a result of osteoporosis.

By working with the hospital and GPs, FLS specialist nurses are able to identify people at risk of osteoporosis, invite them for an assessment and refer them for help where necessary.

This service will help reduce the burden of fracture injuries on the NHS, as an estimated £2.3 billion is spent annually on hip fractures, which account for over two million hospital bed days – more than the number of bed days for heart attacks and strokes combined.[1]

Once an individual suffers a fracture they are at a greater risk of further breaks; a first fracture is therefore the key point for assessment and treatment. If every individual over 50 who breaks a bone is identified and treated by an FLS, 22,250 hip fractures a year could be prevented.[2]

[1] Liberating the NHS: Transparency in outcomes-a framework for the NHS. Department of Health. 19.7.2010: p.31 -fig 6.

[2] McLellan AR, Reid DM, Forbes K et al. NHS Quality Improvement Scotland. Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland. 2004.

Claire Severgnini, Chief Executive of the National Osteoporosis Society, said:

“Fracture Liaison Services can have a huge impact on the quality of life for people with osteoporosis and can ultimately prevent unnecessary deaths. The service plays a crucial role in identifying the condition and reducing the pain and suffering caused by osteoporosis, while relieving the burden on the NHS and saving money.

“We know from a survey of our members that a fifth of women who have fractured a bone, sustain three or more breaks before being diagnosed and that must change. We want people with osteoporosis to be identified after one break and receive the treatment and care they need. In order to do that, the provision of Fracture Liaison Services needs to increase drastically; currently, fracture prevention is postcode driven and we want it to be nationwide.”

As a charity, we are supporting the growth and improvement of this service in a number of ways:

We have produced a set of UK Clinical Standards for FLS (Effective Secondary Prevention of Fragility Fractures: Standards for Fracture Liaison Services), that sets out 10 criteria that every FLS should meet, distilled from the evidence-base on effective care.

We have produced a FLS Implementation Toolkit to enable localities to successfully fund and establish an FLS, underpinned with support from NHS England and Public Health England.

We assist in the CPD of health professionals through the development of the first accredited online training programme for Fracture Prevention Practitioners and The National Training Scheme for Bone Densitometry.

We drive up quality through our Peer Review process for Osteoporosis and Metabolic Bone Services which assess FLSs against the FLS Clinical Standards. This supportive process allows sites to gain insight on their performance and identifies areas for improvement.

We are supporting a National Audit, representing the views of patients on the FLS Database Advisory Group, which is tasked with testing the feasibility of collecting national data on activity to prevent falls and fractures. Data in this area is vital to driving up standards and ensuring better patient outcomes.

We are encouraging MPs to work with local Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBs) in their constituencies to ensure FLS are commissioned. We ask them to write to Health Ministers and table PQs asking for falls and bone health assessments in older people following a fracture to be included in key NHS policy frameworks.