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ONZ Clinical Standards for FLS

Clinical Standards launched to prevent older Kiwis from sustaining recurrent fragility fractures

Today, Osteoporosis New Zealand has published new Clinical Standards for Fracture Liaison Services  that underpin a nationwide strategy to prevent older Kiwis who sustain a fragility fracture from breaking other bones in the future. A fragility fracture is defined as a fracture resulting from low trauma, such as a fall from standing height. The most common skeletal sites of fragility fractures are the hip, wrist, humerus, pelvis or spine.

Every year, about 30,000 fragility fractures occur in New Zealand, predominantly among Kiwis aged 50 years or older. Fragility fractures impose a significant burden on the people who sustain them, their family members, whānau and carers, and the health and social care system. Hip fractures are often considered the most debilitating fragility fracture, for good reason:

  • Less than 50% of people who survive a hip fracture will walk unaided again and in many cases they will never regain their former degree of mobility.
  • A year after hip fracture, 60-80% of survivors require assistance with activities such as dressing, shopping or driving.
  • 10-20% of people who sustain a hip fracture will be admitted to a care home in the year after fracture.

The Accident Compensation Corporation (ACC, the Crown entity responsible for injury prevention) estimates the current 155,000 claims each year for falls and fracture-related injuries among New Zealanders aged 65 years or over costs NZ$195 million, which represents a 47% increase since 2013. Further, ACC estimates that the costs of ‘doing nothing’ would reach NZ$400 million by 2035.

Fracture begets fracture

We have known since the 1980s that up to half of people who present to hospital with a hip fracture had broken another bone in the months or years before breaking their hip. We also know that roughly half of people who sustain a first fragility fracture at any skeletal site will go on to break another bone, with the risk of further fractures rising exponentially with each new fracture.

The Fracture Liaison Service (FLS) model of care has been developed throughout the world to ensure that a determined effort is made to make the first fragility fracture the last. An FLS seeks to ensure that when a person presents to urgent care with a fragility fracture that they receive the investigations, information, and interventions they need to reduce their risk of future fractures. This often includes treatment with safe and effective PHARMAC funded treatments for osteoporosis and referral to local falls prevention services.

Currently, FLS across New Zealand are working towards delivering a world-class service in accordance with the International Osteoporosis Foundation Capture the Fracture® Best Practice Framework. The second edition of the Clinical Standards for FLS in New Zealand will play a vital role in supporting this nationwide clinical quality improvement effort. Participation in the New Zealand arm of a new Australian and New Zealand Fragility Fracture Registry will enable FLS teams to benchmark the care that they provide against the Clinical Standards in real time.

Christine Gill, Executive Director of Osteoporosis New Zealand said, “The Clinical Standards were subject to a broad consultation process with learned societies and government agencies in New Zealand, and leading international organisations in the fragility fracture prevention arena.” Ms. Gill added “We are delighted that 17 organisations have endorsed the Clinical Standards, which illustrates the broad consensus among healthcare professionals regarding the benefits that Fracture Liaison Services bring to patient care.”

Dr. Philippe Halbout, Chief Executive Officer of the International Osteoporosis Foundation noted, “This nationwide effort to develop universal access to IOF Gold Star accredited FLS is a fantastic step forward for the care of people with fragility fractures in New Zealand, and a beautiful example of multisector collaboration which IOF will share with colleagues throughout the world”.

Paul Kennedy, ACC Targeted Investment Manager, highlighted ACC’s ongoing commitment to FLS and other measures to reduce falls and fracture incidence and severity in New Zealand. “International evidence tells us that Fracture Liaison Services play a critical role in identifying and addressing the underlying issues that could lead to subsequent fractures. We’re working with District Health Boards across New Zealand to embed world-class Fracture Liaison Services into the country’s health system”. Mr. Kennedy added, “ With the population of over 65s expected to continue growing rapidly between now and at least 2038, it makes sense to invest in a programme that can enable over 65s to remain fit and well, and in doing so reduce growing demand on New Zealand’s health system.”

About Osteoporosis New Zealand

Osteoporosis New Zealand (ONZ) is the only national charitable trust dedicated to improving care and outcomes for people at high risk of developing or living with osteoporosis. ONZ provides advice, educational material, and information for the public, and make recommendations for the management of osteoporosis by the medical profession. To learn more about Osteoporosis New Zealand and to download the second edition of the Clinical Standards for Fracture Liaison Services in New Zealand, visit:


For more information, contact:

Christine Gill, Executive Director, Osteoporosis New Zealand, Wellington, NEW ZEALAND

Email:   christine.gill@osteoporosis.org.nz