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What is Fracture Liaison Service?

A cost effective model to get patients who have had an osteoporotic fracture on appropriate treatment.

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Low-trauma (sometimes referred to as fragility fractures) occur spontaneously or following minor trauma such as coughing, sneezing or falling from standing height. Individuals who sustain such a fracture are at a much higher risk of sustaining a second or third fracture, leading to progressive disability, chronic pain and decreased quality of life. Despite the availability of effective treatments that can reduce future fracture risk by up to 50%, less than 20% of patients suffering low-trauma fractures receive such treatments in their post-fracture care. This is the post-fracture osteoporosis care gap.

 

Systematic reviews of different clinical models of care designed to close the osteoporosis care gap have found that the Fracture Liaison Service (FLS) model was the most effective at improving patient care outcomes after an osteoporosis related fracture. Integral to an FLS program is a dedicated coordinator who pro-actively identifies fracture patients, determines their risk of having repeat fractures and facilitates effective osteoporosis treatment for high-risk patients. FLS programs “capture” the patients at the point of orthopedic care, and seamlessly integrate secondary fracture prevention into the acute fracture experience. The coordinator also links with primary care providers to maintain communication during patient assessment and upon discharge from the FLS to ensure sustainability and follow-through of initiated interventions. FLS will improve osteoporosis care for fracture patients in addition to reducing overall healthcare costs by preventing expensive repeat fractures.

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The 3 i's

Osteoporosis Canada’s (OC) defines FLS as:  ‘a specific systems-based model of care for secondary fracture prevention where a dedicated FLS coordinator’:

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The 8 essential elements

These are the essential elements as per Osteoporosis Canada (OC). For further details see full document on OC website.

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Osteoporosis Canada Resources

FLS Hub

Explore how OC supports the implementation of quality FLSs across Canada

FLS Toolkit

Broad range of tools to support FLS implementation

FLS Toolkit Appendices

Additional practical tools and resources for FLS implementation

White Board Video

Educational video to help decision makers understand the FLS model

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FLS in BC

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Peace Arch Hospital FLS

Chilliwack General Hospital FLS

Chilliwack General Hospital is proud to have started a new Fracture Liaison Service program in December 2021. Through our FLS coordinator, we have been assessing inpatient hip fractures and outpatient fragility fractures including fractures of the wrist and humerus. We are eager to increase the awareness of osteoporosis in our community and engage with health professionals to help reduce recurrent fractures and hospitalizations. With the partnership of other developing FLS programs in the lower mainland, we are excited to continue to expand our program and share our success to encourage future development of more FLS programs in BC.

Richmond Hospital FLS

The Richmond FLS has been operational since September 2022, supported by the Vancouver Coastal Health Authority. Currently, the FLS is seeing hip fracture patients, and will soon expand to outpatient cast clinic. 

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Ideas for funding

Looking to get the discussion started about FLS implemented in your region? Consider applying for funding for collaboration. Here are some options in BC.

Facility Engagement

Facility Engagement was launched by the Specialist Services Committee in 2016 as a BC-wide initiative to strengthen communication, relationships and collaboration between facility-based physicians and their health authorities. The goal is to increase meaningful physician involvement in health authority decisions about their work environment and the delivery of patient care.

Shared Care

Formed in 2006 as part of the Physician Master Agreement, the Shared Care Committee is one of four Joint Collaborative Committees (JCCs) representing a partnership of the government of BC and Doctors of BC.

Health System Redesign

An initiative under the Specialist Services Committee. The purpose is to compensate physicians at the sessional rate for participation in time-limited, project-based, system redesign work within a health authority or community with health authority involvement.

Your Hospital Foundation

Most hospitals have a foundation supported by donors. The foundations may provide short-term funding for initiatives focused on transforming and bettering health care. Consider reaching out to your local hospital foundation for a discussion.

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