Fracture Liaison Services Tackle Osteoporosis Surge

Fracture Liaison Services (FLS) play a critical role in addressing the growing global burden of osteoporosis-related fractures, particularly hip fractures, a Monash University expert says. A Perspective article in the New England Journal of Medicine shows that, without intervention like FLS, the total number of hip fractures globally could nearly double by 2050. The paper's author, Monash University and Monash Health's School of Clinical Sciences and Department of Medicine Head, Professor Peter Ebeling AO, argues the services can also deliver a return of $10.49 for every $1 invested. The World Health Organization has identified osteoporosis as a major global health issue because it poses significant risks of disability and premature death. Osteoporosis-related fractures are a leading cause of disability and long-term care needs for older adults, with hip fractures being particularly devastating. The Perspective reports that within the first 12 months following a hip fracture, mortality rates range from 14.4 per cent to 28.3 per cent for community-dwelling individuals and up to 55 per cent for residents of long-term care facilities. Designed to bridge the disconnect between acute fracture care and long-term osteoporosis management, Fracture Liaison Services (FLS) are specialised programs that ensure patients who experience a fragility fracture (low-impact fractures that indicate osteoporosis) are systematically identified, assessed, and treated to prevent future fractures. The article outlines four FLS models, which may include medication, lifestyle modifications such as exercise and fall prevention education, and coordination between primary and specialty care providers. FLS programs have been shown to reduce the risk of secondary fractures by up to 74 per cent in the first year and 32 per cent in subsequent years. In the article, Professor Ebeling says FLS programs offer substantial financial benefits, including a return of $10.49 for every $1 invested. Health care systems like Kaiser Permanente in the USA, which have successfully implemented FLS, report significant reductions in fracture rates, underscoring the cost-effectiveness of this approach. However, despite advancements in treatment, less than 20 per cent of all patients who experience fragility fractures receive the recommended pharmacologic treatments to strengthen bone and prevent further fractures. This gap underscores the importance of post-fracture care programs like FLS. "The burden of fragility fractures on health care systems is substantial, demanding coordination across multiple specialties including primary care, geriatrics, orthopedics and rehabilitation," Professor Ebeling said. "Countries like the United Kingdom, Australia and Japan already benefit by implementing FLS. The problem in the US is the current lack of reimbursement for FLS-related services, which decreases the likelihood of health care institutions' decisions to invest in FLS offerings. This is really a missed opportunity for fracture prevention and improved patient outcomes." Ongoing advocacy efforts by organisations, such as Healthy Bones Australia, aim to increase FLS in Australia. This would allow health care providers to establish and sustain FLS programs, ultimately reducing the burden of osteoporosis-related fractures nationwide. This Perspective was a joint effort by lead author Nicola Napoli, MD, PhD, Professor of Endocrinology at Università Campus Bio-Medico di Roma, Rome, Italy; co-author Douglas P. Kiel, M.D., M.P.H., a Senior Scientist at Hebrew SeniorLife's Hinda and Arthur Marcus Institute for Aging Research, an affiliate of Harvard Medical School, Boston, Massachusetts, USA; and Professor Ebeling.