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 systematic review and meta-analysis showing FLS to be the most effective organizational structure for risk evaluation and treatment initiation 1.
Key Differences
- PFC programs typically focus on the immediate care and healing of the fracture, including treatments like casting, physical therapy, and pain management, with some basic osteoporosis screening.
- FLS, on the other hand, is a coordinated service that systematically identifies all patients with fragility fractures, assesses their fracture risk, and implements comprehensive secondary fracture prevention strategies, including bone health assessment, falls risk evaluation, and initiation of appropriate osteoporosis medications.
- The FLS model is characterized by a dedicated coordinator, often a well-educated nurse working under the supervision of an orthopaedic surgeon, endocrinologist, or rheumatologist, who oversees all aspects of the process, from identification and investigation to intervention and therapy 1.
Effectiveness of FLS
- Randomized controlled trials (RCTs) have proven that a nominated coordinator in an FLS significantly improves the implementation of osteoporosis treatment after a fragility fracture, with one cluster RCT showing 45% of patients receiving appropriate management in the intervention group versus 26% in the control group within 6 months after the fracture 1.
- The systematic approach of FLS has been associated with a significant reduction in secondary fracture rates, highlighting its effectiveness in preventing subsequent fractures compared to less comprehensive PFC programs.
Comprehensive Approach of FLS
- FLS includes systematic case finding, bone health assessment (including DXA scans), falls risk evaluation, and initiation of appropriate osteoporosis medications such as bisphosphonates, denosumab, or anabolic agents like teriparatide when indicated.
- Long-term monitoring of treatment adherence and outcomes is also a critical component of FLS, ensuring that patients receive continuous care and support to prevent future fractures.
From the Research
Definition and Purpose
- Post-Fracture Care (PFC) and Fracture Liaison Service (FLS) are two approaches to managing patients with fragility fractures.
- The primary goal of both PFC and FLS is to prevent subsequent fractures and improve patient outcomes 2, 3.
- FLS is a more comprehensive and multidisciplinary approach that aims to identify and treat patients with osteoporosis and other underlying conditions that contribute to fragility fractures 4, 5.
Key Components
- FLS typically involves a coordinated team of healthcare professionals, including orthopedic specialists, primary care physicians, and nurse practitioners 3, 6.
- The FLS team works together to identify patients at high risk of subsequent fractures, conduct diagnostic tests, and initiate treatment plans 2, 4.
- PFC, on the other hand, may involve more traditional and fragmented approaches to managing patients with fragility fractures, with less emphasis on multidisciplinary care and coordination 2.
Benefits and Outcomes
- Studies have shown that FLS programs can significantly improve patient outcomes, including increased rates of osteoporosis diagnosis and treatment, reduced mortality and refracture rates, and lower healthcare costs 2, 3, 5.
- FLS programs have also been shown to improve the quality of care and reduce the gap between evidence-based recommendations and actual clinical practice 2, 4.
- The effectiveness of PFC is less well-studied, but it is generally considered to be less effective than FLS in preventing subsequent fractures and improving patient outcomes 2, 3.
Models and Implementation
- There are different models of FLS, ranging from simple identification and referral to more comprehensive and multidisciplinary approaches 4, 5.
- The implementation of FLS programs can vary depending on the healthcare setting and available resources, but they often involve the use of cloud-based tools and other technologies to support care coordination and communication 5.
- PFC may involve more traditional and fragmented approaches to managing patients with fragility fractures, with less emphasis on multidisciplinary care and coordination 2.