Fracture Liaison Service programme at Beacon Hospital

What Is Fracture Liaison Service (FLS) Programme?

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 osteoporosis.

Typical osteoporosis fractures occur at:

Hip
Wrist
Upper arm
Pelvis
Spine

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 the 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.

Symptoms of Osteoporosis

The symptom associated with osteoporotic fractures usually is a pain; the location of the pain depends on the location of the fracture. Fractures of the spine (vertebra) can cause severe “band-like” pain that radiates from the back to the sides of the body.

Other symptoms include:

A bone that breaks much more easily than expected

Loss of height over time

A stooped posture

Prevention

Prevention of secondary or subsequent fractures has been recognized as an important strategy in osteoporosis management.

Among the preventive measures for osteoporosis are:

Medications that stop bone loss

Medications that increase bone formation and bone strength

Lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D

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 orthopedic surgeon or emergency physician who provides 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 pride to be the only hospital in Malaysia to implement Fracture Liaison Service (FLS) programme.

Under the FLS programme, a bone evaluation is performed and a personalized plan is developed for an individual to maintain his or her bone health and to prevent future fractures. It has been recognized as a crucial programme worldwide to prevent subsequent fractures and thus, result in significant medical cost savings.

Our Teams

Beacon Hospital is at the forefront of this service that operates under the direction of our orthopedic specialist, and a team comprises of:

Orthopedic Surgeons

General Practitioners (GP)

FLS Nurses/Coordinators

Physicians

Physiotherapists/ Occupational therapists

Dietitians

If you are aged 50 or older and experienced a broken bone, you are encouraged to participate in our FLS programme. Our experienced orthopedic 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
occupational therapists
dietitians

to ensure that you receive comprehensive care and treatments, including adequate:

dietary advice
rehabilitation care
treatment of associated medical problems

Once your bones have been weakened by osteoporosis, the following will be the procedure that would be performed:

Diagnosis of osteoporosis with DXA scan if necessary and appropriate anti-osteoporosis treatment will be instituted accordingly.
Upon discharge, 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 the presence of new fragility fractures and whether you are compliant with the prescribed anti-osteoporosis medications.
The follow-up sessions for all FLS patients are for a year.

Our 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.

References:

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.
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

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