Review Question - QID 213992

This patient has recurrent fragility fractures. Referral to a fracture liaison service (FLS) is the best way to ensure patients receive the proper diagnosis and treatment for their osteoporosis.

Osteoporosis is an age-related decrease in bone mass due to a quantitative disorder of bone mineralization. 10 million Americans and 200 million individuals worldwide have osteoporosis. With an aging population these numbers are expected to increase. Over 1.5 million fragility fractures occur each year. In order to reduce the associated morbidity and mortality patient education, diagnosis, and treatment is necessary. Involvement of a fracture liaison service (FLS) with referral to an osteoporosis clinic has shown to be the most successful means in ensuring patients are cared for appropriately.

Bogoch et al. performed a prospective cohort study in which they enrolled patients identified as having a fragility fracture in a coordinator-based fracture liaison service. This resulted in greater than 80% of patients completing bone mineral densitometry, and 80% of patients were assessed by either an osteoporosis specialist or their primary care physician – of these patients over 73% of inpatients and 52% of outpatients received an anti-osteoporosis medication. The authors concluded that a coordinator-facilitated fracture liaison service confers a high rate of education, evaluation and pharmacologic treatment for osteoporosis.

Dreinhofer et al. authored “a global call to action to improve the care of people with fragility fractures” in which they call for the implementation of a systematic approach to fragility fracture care with the goal of restoring function and preventing subsequent fractures. They call for improvements in acute multidisciplinary care for those who suffer fragility fractures, rapid secondary prevention after first occurrence of a fragility fracture, and ongoing post-acute care of individuals whose ability to function is impaired by fragility fractures. They conclude that an intense multinational effort will be required to address the fragility fracture crisis.

Miller et al. described a fracture liaison service (FLS) for the care of patients with fragility fractures. This service funcions with three key personnel: the FLS coordinator (usually an advanced practice provider), a physician champion (usually an orthopaedic surgeon), and a nurse navigator. They concluded that fragility fracture care requires active osteoporosis management in addition to the surgeon’s operation to stabilize a broken bone.

Figure A are x-rays of a dorsally angulated distal radius fracture.

Incorrect answers:
Answer 1: referral to a fracture liaison service ensures that patients receive appropriate diagnosis and treatment for their osteoporosis, so it may indeed increase the number of labs and blood draws the patient requires
Answer 2: though referral to a fracture liaison service is likely to streamline her medical treatment for osteoporosis, it is not likely to reduce the number of follow up visits the patient requires
Answer 3: the fracture liaison service makes it more likely that your patient receives referral to an outpatient metabolic bone clinic (endocrinology).
Answer 5: the patient's orthopaedic care is independent of her follow up and medical treatment for osteoporosis.