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Minimal Trauma Fracture Liaison (MTFL) Service, Concord Repatriation General Hospital, Sydney

The Minimal Trauma Fracture Liaison (MTFL) service was established in 2005 at this large tertiary referral centre in Sydney. The MTFL service provides a good illustration of effective collaboration between a physician-led FLS and the hospital’s Orthogeriatrics Service (akin to Geriatric Fracture Center models in the United States); the MTFL provides care for non-frail patients with fragility fractures whilst the Orthogeriatrics Service focuses on frail patients, including the majority of hip fractures. The MTFL is delivered by an advanced trainee (i.e. a physician in his/her 4th-6th year of post-graduate training) which required a 0.4-0.5 FTE appointment.

The impact of the MTFL service was evaluated after 4 years. Fracture patients who chose to decline the consultation freely offered by the service, in favour of follow-up with their primary care physician, were considered as a control group for statistical comparison. Refracture incidence for those patients managed by the MTFL service was 80% lower than the control group. A published cost-effectiveness analysis of the MTFL service reported:

  • A mean improvement in discounted quality-adjusted life expectancy per patient of 0.089 QALY gained
  • Partial offset of the higher costs of the MTFL service by a decrease in subsequent fractures, which lead to an overall discounted cost increase of AU$1,486 per patient over the 10-year simulation period
  • The incremental costs per QALY gained (incremental cost-effectiveness ratio – ICER) were AU$17,291, which is well below the Australian accepted maximum willingness to pay for one QALY gained of AU$50,000

Read more at:

Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Lih A, Nandapalan H, Kim M, Yap C, Lee P, Ganda K, Seibel MJ. Osteoporos Int. 2011 Mar;22(3):849-858. PubMed ID 21107534

Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study. Cooper MS, Palmer AJ, Seibel MJ. Osteoporos Int. 2012 Jan;23(1):97-107. PubMed ID 21953475