From the Guidelines
Post-fracture care programs, also known as Fracture Liaison Services (FLS), come in several formats, including the fully coordinated type A model, the type B format involving a coordinator who identifies patients and makes recommendations, and the simplest type C format where patients are identified and information is sent to primary care without direct coordination. These programs are designed to prevent secondary fractures in patients who have already experienced a fragility fracture. According to the most recent and highest quality study 1, the clinical and cost-effectiveness of coordinated multidisciplinary post-fracture models of care has been confirmed, with orthogeriatric services and multidisciplinary FLS reducing relative risk of in-hospital and long-term mortality compared with standard care.
The different formats of post-fracture care programs/ Fracture Liaison Services include:
- Type A model: a fully coordinated model where dedicated personnel identify, investigate, treat, and monitor patients throughout their care journey
- Type B format: a coordinator who identifies patients and makes recommendations but transfers responsibility to primary care for treatment initiation
- Type C format: the simplest format, where patients are identified and information is sent to primary care without direct coordination These programs typically include bone mineral density testing, fall risk assessment, medication initiation, calcium supplementation, vitamin D supplementation, and lifestyle modifications. Effective FLS programs reduce secondary fracture rates by 30-50% by addressing the significant care gap where many fracture patients don't receive appropriate osteoporosis treatment, as shown in a meta-analysis of 19,519 participants who had experienced an osteoporotic fracture 1.
Implementation of FLS programs requires dedicated personnel, clear protocols, and integration with existing healthcare systems to ensure patients receive timely and appropriate interventions following a fracture, as recommended by the 2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older 1. The EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures also emphasize the importance of a systematic evaluation of patients for the risk of subsequent fractures and the effectiveness of FLS in reducing re-fracture rates 1.
From the Research
Post-Fracture Care Programs
The different formats of post-fracture care programs, also known as Fracture Liaison Services (FLS), can be categorized into several types, including:
- Fracture Liaison Services (FLS) models, which are multidisciplinary approaches to secondary fracture prevention 2
- Geriatric/orthogeriatric services, which are also common models of post-fracture care programs 3
- Type A FLS Models, which are the most successful in initiating diagnostic and treatment plans for fragility fracture patients 2
Characteristics of Post-Fracture Care Programs
The key characteristics of post-fracture care programs include:
- Evaluation and management of patients with minimal trauma or fragility fractures to prevent subsequent fractures 3
- Coordinated, multidisciplinary care to improve post-fracture outcomes and reduce recurrent fractures 2
- Simple, targeted, and high-yield programs that have the potential to protect vulnerable patients 2
Effectiveness of Post-Fracture Care Programs
The effectiveness of post-fracture care programs has been evaluated in several studies, which have shown that:
- FLS programs improve outcomes of patients with osteoporosis-related fractures, with significant increases in bone mineral density (BMD) testing, treatment initiation, and adherence to treatment, and reductions in re-fracture incidence and mortality 4
- FLS programs are cost-effective and can lower healthcare costs while improving patient outcomes 2, 3
- The quality of evidence supporting associations between FLS programs and improved outcomes is moderately strong due to the availability of longitudinal data from nationalized health systems 2