By: 4 October 2019
Scotland becomes second country in the world to have 100 per cent fracture liaison service

The Royal Osteoporosis Society (ROS) has launched new clinical standards for fracture liaison services, as Scotland achieves 100 per cent fracture liaison service (FLS) coverage.

The newly launched ROS Effective Secondary Prevention of Fragility Fractures: Clinical Standards for Fracture Liaison Services gives best practice guidelines for all healthcare professionals and commissioners on the care of fragility fractures and secondary prevention of future fractures in patients aged over 50.

Ali Doyle, head of operations and clinical practice, Royal Osteoporosis Society, said: “Our new clinical standards set the benchmark to improve patient outcomes, use NHS resources appropriately and save money by preventing future fractures. If your local service is not meeting the six important clinical standards you’re either commissioning the wrong service, or delivering a service that needs improvement.”

The new online ROS clinical standards reflect current best practice and embed a strong culture of quality, the 5IQ principle. According to the Royal Osteoporosis Society FLS services should:

  • identify patients aged over 50 who have suffered a fragility fracture
  • investigate to assess bone health and falls risk
  • inform patients to enable them to understand future fracture risk and what can be done to reduce this
  • intervene to improve bone health and referring to other specialist services, including falls prevention
  • integrates patient care across primary and secondary care to ensure long-term management including making sure patients are concordant with their treatment in order to obtain its benefits 
  • have a strong culture of quality that is inclusive, responsive and responsible to individual patients and the health economy.

The ROS has a fracture liaison service toolkit to help NHS bodies such as clinical commissioning groups, health boards or hospitals set up or improve existing FLS services. The toolkit helps NHS organisations understand the local impact of these broken bones in terms of numbers and socio-economic costs, predicts impacts for the next 5-10 years, provides a local model of the clinical and cost effectiveness of such a service, evidence-based business case, taking a system-wide approach to falls and fractures prevention, for commissioning. The ROS can also support with the implementation of the new service.

Scotland has just become the second country in the world, after New Zealand, with 100 per cent FLS provision across all health boards. The fracture liaison service originated in Scotland, with the world’s first FLS opening in Glasgow nearly 20 years ago.

Dr Stephen Gallacher, consultant physician and endocrinologist, NHS Greater Glasgow and Clyde, said: “People who suffer a low trauma fracture are twice as likely as the general population to suffer a second fracture. This is the basis of the fracture liaison service. The FLS sees and assesses people who present with a low trauma fracture.”

Scotland’s 100 percent FLS coverage is expected to prevent 4,589 broken bones (including 1,925 hip fractures) and save £37.5m for local health and social care economy over five years.