Fracture Liaison Service: first fracture care as a prevention tool 

One of the most important responses to an osteoporosis-related fracture is the care the patient receives during the healing process, and thereafter in order to prevent further fractures. It is well known that a first fracture due to osteoporosis is often not the last – and to prevent that inconvenience from happening again, the Fracture Liaison Service has a number of treatments and advice up their sleeve.

A first fracture may actually be the first time an individual learns that they have osteoporosis. Thus it is often called a ‘signal fracture’. Not only does the break present a problem, but the patient has to process their new medical status. They need the kind of support and guidance not always available after they have recovered physically. This is the point at which they need to adapt to the fragility of their bones and receive treatment for the underlying osteoporosis.

Post-fracture care is vital if the patient is to avoid further fractures, which present great expense to both quality of life and the healthcare system. The Fracture Liaison Service ensures that all patients who present with a ‘signal’ fracture receive the osteoporosis care they need to prevent future fragility fractures. And the results are very positive – significantly reducing the incidence, disability and cost of repeat fractures.

The post-fracture osteoporosis and FLS programmes

Individuals who suffer a fragility fracture are at substantially increased risk of suffering second and subsequent fractures. Crucially, half of all patients who suffer a hip fracture had previously broken another bone — a ‘signal’ fracture. Unfortunately, osteoporosis is not always diagnosed when ‘signal’ fractures occur. This has created a ‘care gap’ which FLS has been designed to fill.

The main objectives:

  • Identification: All men and women over 50 years of age who present with fragility fractures will be assessed for risk factors for osteoporosis and future fractures.
  • Investigation: Those at risk will be required to undergo bone density testing.
  • Initiation: If evidence of osteoporosis is found, the FLS will leap into action with a programme of suitable, customised treatments.

 The Benefits of FLS:

  • Improved quality of life and enhanced independence for seniors
  • Reduced incidence of avoidable — and often life-threatening — fractures
  • Reduced disruption to patient flow in the health care system by decreasing pressures on already scarce orthopaedic resources
  • Freeing up capacity for elective surgery and reducing the pressure on available beds and home care, providing significant cost savings.

How FLS programmes work

  • Fracture Liaison Service programmes help to co-ordinate patient post-fracture care. If you break a bone, it is very important that you get the right medical care, treatment and follow-up to make sure you don’t break any more bones.
  • A fracture prevention program provides a bone evaluation and develops a personalised plan for you to reach and maintain your optimum bone health to prevent future broken bones.
  • Your medical and family history will be reviewed, and your risk for another broken bone will be evaluated. Your bone density will be measured, your diet investigated regarding calcium and Vitamin D intake. From this, treatment options will be discussed.
  • It is important to let your doctor know the medications you have been taking during the last 10 years because some are known to increase an individual’s risk for low bone mass and fractures.
  • The FLS programme should operate under the direction of your doctor and an FLS Co-ordinator.
  • Your active participation and positive attitude will certainly help you along this journey to better bone health.
  • The FLS will arrange regular follow-up visits. They will monitor your bone health, and advise lifestyle practices to help you remain fit and healthy.
  • Care co-ordination is one of the most important parts of any Fracture Liaison Service programme. You will need to participate positively by sticking to the rehabilitation plan, following up on medical appointments, and staying on prescription medication to prevent broken bones.
  • You can expect counselling on fall prevention and safety measures; as well as diet, exercise, and lifestyle changes such as reducing alcohol intake and stopping smoking.

The FLS programme was initiated by the International Osteoporosis Foundation (IOF) several years ago as a global initiative and many countries have now enrolled several hospitals into this programme. South Africa currently has two hospitals and we are trying our utmost to get Medical Aids, the Department of Health and other stakeholders interested in supporting this initiative which will have an enormous influence on decreasing costs (preventing further fractures and expensive hospitalisation and surgery), ensuring the best and sustained care of post-operative osteoporosis patients, thereby increasing quality of life and longer independence for our seniors. Please help us spread this message as wide as you can – patient voices are often the ones better heard by those who need to take notice!!

Love your bones! Even when one gives up on you, respond with the best care, information, and attention you can – and help save the rest.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

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