What are effective case studies of Post-fracture care programs, specifically Fracture Liaison Services (FLS), in the United States?

From the Guidelines

Fracture Liaison Services (FLS) have been shown to be effective in reducing subsequent fractures and improving osteoporosis management in patients with fragility fractures, with a meta-analysis demonstrating a 30% reduction in re-fracture rates compared to no FLS or usual care 1. The key components of successful FLS programs include systematic identification of fracture patients, risk stratification, and initiation of evidence-based treatments such as bisphosphonates, vitamin D, and calcium supplementation, as well as fall prevention education.

• Effective FLS programs often involve a dedicated coordinator, such as a nurse practitioner, who oversees the care of fracture patients and ensures that they receive appropriate osteoporosis evaluation and treatment.
• The success of FLS programs can be attributed to their ability to close the care gap that often exists after a fragility fracture, when many patients may not receive timely and appropriate osteoporosis evaluation and treatment despite their high risk for subsequent fractures.
• Studies have consistently shown that FLS programs can lead to significant improvements in osteoporosis medication adherence, bone mineral density testing, and treatment rates, as well as reductions in subsequent fractures and related healthcare costs 1.
• The most recent and highest quality study on this topic, published in 2021, confirms the clinical and cost-effectiveness of coordinated multidisciplinary post-fracture models of care, including FLS, in reducing re-fracture rates and improving patient outcomes 1.
• In real-life clinical practice, implementing an FLS program can be an effective strategy for improving the management of patients with fragility fractures and reducing the risk of subsequent fractures, and healthcare providers should consider establishing or participating in an FLS program to improve patient outcomes and reduce healthcare costs.

From the Research

Effective Case Studies of Post-fracture Care Programs

• Fracture Liaison Services (FLS) have been shown to be effective in improving post-fracture care and reducing the risk of subsequent fractures 2, 3, 4.
• Studies have demonstrated that FLS programs can improve rates of bone mineral density scanning and antiresorptive therapy, as well as reduce the rates of new fractures and mortality among patients with minimal trauma fractures 3.
• The efficacy of FLS programs has been correlated with their intensity, with Type A FLS models being the most successful in initiating diagnostic and treatment plans for fragility fracture patients 2.

Characteristics of Successful FLS Programs

• Successful FLS programs often involve a multidisciplinary approach, with coordination between healthcare providers, including primary care physicians, orthopedic specialists, and other healthcare professionals 2, 5.
• These programs often include a single entity providing cohesive and consistent training, coordination, shared goals, and accountability for program sites and site leaders 5.
• Creating a partnership with shared goals with primary care providers is a challenge for every program, but is crucial for maintaining program effectiveness and cohesion when the patient transitions from acute care to primary care 5.

Economic Benefits of FLS Programs

• FLS programs have been shown to be cost-effective, with one study estimating that an FLS could result in cost savings of $66,879 per 10,000 postfracture patients, as well as reduced fractures and improved quality-adjusted life years (QALYs) 6.
• The cost-effectiveness of FLS programs has been demonstrated to be robust to plausible ranges of input parameters, with an incremental cost-effectiveness ratio (ICER) of $22,993 per QALY in one study 6.

Geographic Variations in FLS Programs

• There are geographic variations in the implementation and effectiveness of FLS programs, with some countries having more established programs than others 4.
• The United States has been noted to lag behind other countries in overcoming the challenge of maintaining program effectiveness and cohesion when the patient transitions from acute care to primary care 5.