Using nurse-led liaison to prevent further fractures.

Osteoporosis-related fractures are common and associated with substantial morbidity and mortality. Having one such fracture at least doubles the risk of experiencing another. Nurse-led assessment of future fracture risk and of any underlying osteoporosis can ensure treatment is offered to reduce the risk of another fracture. However, many hospitals do not offer a fracture liaison service, although evidence shows these services deliver high-quality care in a systematic way and are cost effective. In Glasgow, hip fracture rates have fallen over a decade since a fracture liaison service, was introduced while fracture rates have risen elsewhere. Nurses working in hospitals that do not have secondary prevention services should advise patients to seek these through their GP.

Vertebral fracture assessment in patients presenting with incident nonvertebral fractures.

BACKGROUND: Patients with fractures should be prioritized for assessment for osteoporosis so that they can benefit from treatment for the secondary prevention of osteoporotic fractures. Assessment is seldom offered to patients with vertebral fractures because these fractures are typically not diagnosed. Vertebral fractures can be identified by vertebral fracture assessment (VFA) using current dual-energy X-ray absorptiometry (DXA) scanners. OBJECTIVE: The purpose of this study was to assess the prevalence of vertebral fractures, using VFA, in patients presenting with nonvertebral fractures and to assess whether this impacts on the management of these patients. DESIGN: A cohort study undertaken in 577 patients aged 50 years or over including 455 women, who presented with nonvertebral fractures and who underwent routine post-fracture assessment by a Fracture Liaison Service (FLS). MEASUREMENTS: The numbers and severity of vertebral fractures were assessed in evaluable vertebrae from TV4 to LV4 in addition to bone mineral density (BMD) assessment. RESULTS: Using DXA, 76% of vertebrae could be evaluated by VFA. Of the men and women with nonvertebral fractures, 19-20% had at least one vertebral fracture. The prevalence ranged from 6% in men with humeral fractures to 32% among women with hip fractures. The prevalence of vertebral fractures correlated most strongly with increasing age and with severity of reduction of BMD. Using local treatment protocols, VFA would result in only 3% more patients receiving treatment for fracture secondary prevention. CONCLUSIONS: In patients with nonvertebral fractures, VFA identifies a substantial burden of prevalent vertebral fractures that have not hitherto been recognized. Nevertheless, VFA seldom influences the need for treatment for fracture secondary prevention after a nonvertebral fracture.

A fracture liaison service for patients with osteoporotic fractures.

A fracture liaison service, led by a specialist nurse, has been set up in one trust to offer an assessment for osteoporosis to all men and women over 50 with new fractures. The aim is to identify those who have osteoporosis because they are at greatest risk of further fractures. The service delivers strategies to reduce future fracture risk, targeted at those patients at highest risk.

The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture.

INTRODUCTION: Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow. METHODS: An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. RESULTS: During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service's osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine. CONCLUSIONS: The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.