Osteoporosis is the most common chronic bone disease which predisposes an individual to an increased risk of fracture. At least 1 in 3 women and 1 in 5 men will suffer a fragility fracture in their lifetime due to osteoporosis1,2. Typical osteoporosis fractures occur at the hip, wrist, upper arm, pelvis and spine. Hip fractures are the most devastating of all fragility fractures and are a major cause of morbidity in the elderly3. In Malaysia, the Chinese had the highest incidence of hip fractures compared to Malays and Indians4. Most hip fracture patients are unable to regain their ability to live independently and experience a significant reduction in their quality of life.
In addition, individuals who suffer a fragility fracture are at substantially increased risk of suffering second and subsequent fractures. Approximately half of patients who suffer a hip fracture had previously broken another bone – a ‘signal’ fracture – before breaking their hip5. It is therefore recommended that after a fragility fracture, patients should be assessed and treated for osteoporosis in order to reduce the risk of second and subsequent fractures, particularly of the hip6.
Prevention of secondary or subsequent fractures has been recognised as an important strategy in osteoporosis management. However, the awareness of post-fracture intervention among the community is generally poor. In most cases, the fracture is treated as an acute event by the orthopaedic surgeon or emergency physician who provide the best of immediate care for the fracture. The patients also treat their fracture as an acute event as they are unaware of their bone fragility.
Recognizing the importance of providing secondary preventive care to the post-fracture patients, Beacon Hospital takes the pride to be the first hospital in Malaysia and South East Asia to implement Fracture Liaison Service (FLS) programme. Under the FLS programme, a bone evaluation is performed and a personalized plan is developed for individual to maintain his or her bone health and to prevent future fractures. It has been recognised as the most important programme worldwide to prevent subsequent fractures and thus result in significant medical cost savings. Beacon Hospital to be the forefront of this service that operates under the direction of our orthopaedic specialist, and the team comprise of:
- Orthopaedic Surgeons
- General Practitioners (GP)
- FLS Nurses/Coordinators
- Physiotherapists/ Occupational therapists
If you are aged 50 or older and experienced a broken bone, you are encouraged to participate in our FLS programme. Our experienced orthopaedic surgeons will look into your fragility fractures problem. At the same time, you will also be referred to our FLS team which consist of physicians, physiotherapist or occupational therapists and dietitians to ensure that you receive comprehensive care and treatments, including adequate dietary advice, rehabilitation care and treatment of associated medical problems. Diagnosis of osteoporosis with DEXA scan if necessary and appropriate anti-osteoporosis treatment will be instituted accordingly. Upon discharged, you will be referred to your family doctors (general practitioners) to continue your anti-osteoporosis treatments. You will be then followed up with phone calls periodically by our FLS nurses/FLS coordinators to assess presence of new fragility fractures and whether you are compliant with the prescribed anti-osteoporosis medications. All FLS patient will be followed up for a year.
The FLS program is endorsed by the International Osteoporosis Foundation (IOF) as the optimal model of care to eliminate the post-fracture osteoporosis care gap by ensuring that all fragility fracture sufferers receive the secondary preventive care they need.
- Van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. Dec 2001;29(6):517-522.
- Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. Oct 19 2012.
- Foster KW. Hip fractures in adults [Internet]. UpToDate: c2017 [cited 2017 Sept 19]. Available from http://www.uptodate.com/content/hip-fractures-in-adults.
- Lee JK, Khir ASM. The incidence of hip fracture in Malaysians above 50 years of age: variation in different ethnic groups. APLAR J Rheumatol 2007;10:300-5
- Edwards BJ, Bunta AD, Simonelli C, Bolander M, Fitzpatrick LA. Prior fractures are common in patients with subsequent hip fractures. Clin Orthop Relat Res. Aug 2007;461:226-230.
- 6.Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris ST, Hodgson SF et al. American association of clinical endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract 2010:16(Suppl 3): 1-37