Background Fracture Liaison Services (FLS) can prevent secondary fracture through systematic identification of low trauma fractures using dedicated case finding, with assessment and treatment of osteoporosis where necessary. Services are now being measured for quality against Clinical Standards for Fracture Liaison Services published by the National Osteoporosis Society in 2015. The first standard asserts that all patients over 50 years with a newly reported vertebral fracture will be systematically and proactively identified.
Objectives To evaluate provision for systematic identification of newly reported vertebral fractures in patients aged over 50 at Fracture Liaison Services (FLS) across the UK.
Methods A gap analysis tool was used to measure service provision against standard one of the Clinical Standards for Fracture Liaison Services, relating to the systematic and proactive identification of vertebral fractures. Data was collected at 78 sites in the UK.
Results 63% (49) of sites had no systematic process in place to identify vertebral fractures. Only 10% (8) sites identified all newly reported vertebral fractures. 27% (21) had procedures in place to identify some vertebral fractures, i.e. those within certain cohorts. There was considerable disparity across the UK. Sites in Scotland were significantly more likely to have comprehensive processes in place (38%, 6/16) than in the rest of the UK (3%, 2/62).
Conclusions Systematic identification of vertebral fractures poses a particular challenge to services due to a number of factors. Vertebral fractures are difficult to identify as they tend not to present or be admitted in acute settings where FLS are primarily based. In addition, services require support from Radiology, including a commitment to avoid ambiguous terminology when reporting vertebral fractures. Furthermore, as a category, vertebral fractures fall between departments (Rheumatology, Orthopaedic, Fracture Clinic, A&E, Spinal services) making systematic identification even more challenging. In the Fracture Liaison Service Database Facilities Audit (May 2016), the most frequently cited barrier to the identification of vertebral fractures was lack of a patient pathway.
Gap analysis shows a paucity of provision in the identification of vertebral fractures. This is the key driver for work underway in the NOS to develop a patient pathway for vertebral fractures, in conjunction with clinical experts, to promote best practice and best patient care.
Disclosure of Interest None declared