From the Guidelines
The primary distinction between Post-Fracture Care (PFC) and Fracture Liaison Service (FLS) is that FLS provides a more comprehensive and systematic approach to secondary fracture prevention, as evidenced by a meta-analysis showing a 30% reduction in re-fracture rates compared to no FLS or usual care 1.
Key Differences
- PFC programs focus on basic follow-up care after a fracture, including healing of the immediate injury through treatments like casting, physical therapy, and pain management.
- FLS, on the other hand, is a coordinated, multidisciplinary service that identifies all patients with fragility fractures, assesses their fracture risk, and implements comprehensive secondary fracture prevention strategies.
Components of FLS
- Systematic case finding
- Bone health assessment (including DXA scans)
- Falls risk evaluation
- Initiation of appropriate osteoporosis medications (such as bisphosphonates, denosumab, or anabolic agents) when indicated
- Long-term monitoring of treatment adherence and outcomes, typically coordinated by a dedicated FLS coordinator
Evidence Supporting FLS
- A study published in the Annals of the Rheumatic Diseases in 2021 found that FLS reduces re-fracture rates by approximately 30% compared to no FLS or usual care 1.
- Another study published in the same journal in 2017 noted that FLS is the most effective organizational structure for risk evaluation and treatment initiation, with a dedicated coordinator improving the implementation of osteoporosis treatment after a fragility fracture 1.
Recommendation
Based on the most recent and highest quality evidence, FLS is the preferred approach for secondary fracture prevention due to its comprehensive and systematic approach, which has been shown to reduce re-fracture rates and improve patient outcomes 1.
From the Research
Overview of Post-Fracture Care (PFC) and Fracture Liaison Service (FLS)
- Post-Fracture Care (PFC) programs aim to evaluate and manage patients with minimal trauma or fragility fractures to prevent subsequent fractures 2.
- Fracture Liaison Service (FLS) is a model of care that uses coordinated, multidisciplinary care to improve post-fracture outcomes and reduce recurrent fractures 3, 4, 5, 6.
Key Differences
- PFC programs focus on the prevention of subsequent fragility fractures, while FLS is a specific model of care that aims to close the care gap in secondary fracture prevention 3, 2.
- FLS models are considered to be the most effective organizational approach for secondary fracture prevention, with evidence showing significant improvements in rates of bone mineral density testing, initiation of osteoporosis treatment, and adherence with treatment 3, 5.
- PFC programs can take various forms, including fracture liaison services and geriatric/orthogeriatric services, while FLS is a specific type of PFC program 2.
Effectiveness and Efficiency
- Studies have shown that FLS care is associated with reduced subsequent fracture and mortality risk, particularly in patients with major/hip index fractures 4.
- The efficacy of secondary fracture prevention programs, including FLS, correlates strongly with their intensity, with Type A FLS models being the most successful in initiating diagnostic and treatment plans for fragility fracture patients 3.
- FLS programs have been shown to be cost-effective, with improvements in patient outcomes and reductions in healthcare costs 3, 2.