The Current State of Fracture Liaison Services in the United States

Fracture Liaison Services (FLS) attempt to ensure that patients with potentially osteoporosis-associated fractures are followed appropriately with screening and intervention. In the United States, industry, non-profits, and governmental steering committees support FLS.

David Lee, MPA, from the National Bone Health Alliance (NBHA), discussed the implementation of Fracture Liaison Services in the United States at the 2014 American Society of Bone and Mineral Research Conference in Houston, Texas.

In the past, when a patient sustained a potentially osteoporosis-associated fracture, the diagnosing physician would identify, investigate, and — optimally – initiate treatment. However, there was some controversy about whether the diagnosing physician, the orthopedist, or the primary care physician would initiate treatment and follow the patient for long-term care. As a result, an estimated 80% of patients who sustained fractures were never offered screening or treatment for osteoporosis.

FLS is a coordinated way to follow up and ensure that patients with osteoporosis are treated appropriately, whether they need osteoporosis treatment, falls risk assessment, exercise, and/or education.

Every year, there are 2 million bone breaks that are clinical signs of osteoporosis. Osteoporosis and low bone mass affect 17% of the US population. It is estimated that 50% of women and up to 25% of men over age 50 years will break a bone due to osteoporosis.

In the United States, the NBHA was launched as a public-private partnership that brings together the expertise and resources of governmental, public, and private resources.

The NBHA set a goal to reduce bone breaks by 20% by the year 2020. There are currently 200 active FLS programs, but a total of 1000 active programs are needed by 2020.

At this time, barriers to FLS implementation in the US include lack of awareness among healthcare providers that patients with a prior fracture are at highest risk for subsequent fractures, not knowing about the FLS model of care, and not having the tools to help interested sites, health care professionals, and administrators.

It is worthwhile not to miss these patients because, as John Eisman, MBBS, PhD from the Gervan Institute of Medical Research, said, “If you only get 10 people, then it is 10 people who otherwise wouldn’t get care.”

FLS efforts include the development of new FLS/Quality Measure Tools such as Fracture Prevention CENTRAL, the FLS Demonstration Project, and the Qualified Clinical Data Registry. The Qualified Clinical Data Registry provides a way for healthcare providers to report on osteoporosis quality measures. In advance of governmental requirements, the Registry will collect medical and clinical data for the purpose of patient and disease tracking and to foster improvements in the quality of patient care.

Industry, non-profits, governmental steering committees, and task forces support implementation of FLS. As Ethel Siris, MD, from Columbia University College of Physicians and Surgeons said, “We know what to do—we just have to do it."