Case study: fracture liaison service at Lille University Hospital, France
This fracture liaison service (FLS) is successfully identifying fracture patients and supporting them, with the aim of preventing subsequent fractures.1
What does the programme involve?
This FLS, active since 2016, includes both an inpatient and outpatient pathway.1 Eligible people are identified in the orthopaedic or emergency departments, or are referred by their primary care physician. Once referred, participants receive a range of assessments, including blood tests and a dual-energy X-ray absorptiometry (DXA) scan which is used to assess bone health. Those who are treated in rheumatology department were followed up within 6-12 months in FLS unit1
What has the programme achieved?
In its first two years, this FLS has performed well in terms of identifying eligible patients and managing the care of those who attended the service:1 2
- Around three in four people who had been admitted to the orthopaedic unit with a hip fracture were identified by the FLS.
- Nearly all patients who attended the service had a DXA scan and blood test, and osteoporosis treatment was prescribed for 94.9% of patients.
- This FLS is registered with the Capture the Fracture programme, which assesses the performance of registered FLS against a set of international best practice standards.
Practice standards. What lessons can be learnt from this programme?
An FLS can support effective identification and management of people who have sustained a fragility fracture and are at risk of subsequent fractures. By including an outpatient pathway into the service, people who have sustained fragility fractures which do not require hospitalisation can be treated before a more serious fracture occurs. However, fewer than half (45%) of those who were referred attended the FLS.1 More effective strategies are needed to encourage participation in these services.
The information in this case study is based on research conducted for the 2020 publication Osteoporosis and fragility fractures: a policy toolkit.
- Pflimlin A, Gournay A, Delabrière I, et al. 2019. Secondary prevention of osteoporotic fractures: evaluation of the Lille University Hospital’s Fracture Liaison Service between January 2016 and January 2018. Osteoporosis International 30(9): 1779-88
- International Osteoporosis Foundation. 2019. Capture the Fracture. Map of best practice. Available from: https://www.capturethefracture.org/map-of-best-practice-page?field_rating_tid=All&country=de [Accessed 01/09/20]