The Glasgow Fracture Liaison Service, Scotland
First developed in 1999, the Glasgow FLS is a system to ensure fracture risk assessment, and treatment where appropriate, is delivered to all patients with fragility fractures. The FLS is a ‘doctor light’ service and is primarily delivered by clinical nurse specialists, who work to pre-agreed protocols to case-find and assess fracture patients. Consultant Endocrinologists provide medical leadership for the Glasgow FLS. A critical success factor in development of the Glasgow FLS was establishment of a multi-disciplinary stakeholder group from project outset, with representation from all relevant hospital specialities, local primary care and regional health authority and administrative groups.
The structure of the Glasgow Fracture Liaison Service
* Older patients, where appropriate, are identified and referred for falls assessment
During the first 18 months of operations:
- More than 4,600 patients with fractures of the hip, wrist, upper arm, ankle, foot, hand and other sites were seen by Fracture Liaison Nurse Specialists
- Nearly three-quarters were considered for BMD testing and treatment was recommended for approximately 20% of patients without the need for BMD testing
- 82% of patients tested were found to be osteopenic or osteoporotic at the hip or spine
During the first decade of this century over 50,000 consecutive fracture patients have been assessed by the Glasgow FLS. During this period, hip fracture rates in Glasgow have been reduced by 7.3% versus almost a 17% increase in England, where only 37% of localities operated a FLS by late 2010. A Scottish national audit compared case ascertainment for hip and wrist fractures in Glasgow versus 5 other centers operating less systematic models of care. Ninety-seven percent of hip fracture and 95% of wrist fracture patients were assessed by the Glasgow FLS versus less than 30% for other service configurations. In May 2011, a formal cost-effectiveness analysis of the Glasgow FLS was published. This study concluded that 18 fractures were prevented, including 11 hip fractures, and £21,000 was saved per 1,000 patients managed by the Glasgow FLS versus ‘usual care’ in the United Kingdom.
Read more at:
The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. McLellan AR, Gallacher SJ, Fraser M, McQuillian C. Osteoporos Int. 2003 Dec;14(12):1028-1034. PubMed ID 14600804
Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D. Osteoporos Int. 2011 Jul;22(7):2083-2098. PubMed ID 21607809