Executive summary - Fragility Fracture Network
FFN Clinical ToolkitA generic fully referenced Fracture Liaison Service business plan templateVersion: 1.0 CleanDate: 13-10-2020Note to business plan authors: Please note that the citations in this document have active EndNote links that have been created with the Thomson Reuters EndNote version X9 software. If you have this software, Reference Manager or other bibliographic software, you could export the Travelling Library into your software package. The output style has been set to Archives of Internal Medicine format.Contents TOC \o "1-3" \h \z \u Executive summary PAGEREF _Toc53498292 \h 1The need for a Fracture Liaison Service in [insert hospital name] PAGEREF _Toc53498293 \h 2The ageing population PAGEREF _Toc53498294 \h 2Hip fractures impose a significant burden on patients and [insert hospital name] PAGEREF _Toc53498295 \h 3An obvious opportunity for intervention: Half of hip fracture patients sustain prior fractures PAGEREF _Toc53498296 \h 3The impact of osteoporosis treatment on secondary fracture incidence PAGEREF _Toc53498297 \h 4Secondary fracture prevention: A global, regional, national and local care gap PAGEREF _Toc53498298 \h 5Current standards of secondary preventive care in [insert hospital name] PAGEREF _Toc53498299 \h 5Fracture Liaison Services: A proven healthcare delivery solution PAGEREF _Toc53498300 \h 5Definition of a high-performing Fracture Liaison Service PAGEREF _Toc53498301 \h 5Examples of high-performing Fracture Liaison Services PAGEREF _Toc53498302 \h 5Benchmarking performance: Clinical Standards for Fracture Liaison Services PAGEREF _Toc53498303 \h 6Endorsement of the Fracture Liaison Service model of care PAGEREF _Toc53498304 \h 7Implementation of a Fracture Liaison Service in [insert hospital name] PAGEREF _Toc53498305 \h 8Budgetary impact of a Fracture Liaison Service in [insert hospital name] PAGEREF _Toc53498306 \h 8Summary PAGEREF _Toc53498307 \h 10References PAGEREF _Toc53498308 \h 11Executive summaryFracture Liaison Services (FLS) improve quality and reduce costs through a reduction in emergency admissions for hip and other fragility fractures.The aim of the proposed FLS is to ensure that all patients aged [XX] years and over who present to [insert hospital name] with a fragility fracture receive assessment and, where warranted, pharmacological treatment for osteoporosis, and referral to local falls prevention services to reduce their risk of subsequent fractures.In 20XX, XXX patients presented with a hip fracture to [insert hospital name] incurring an annual cost of $YYY,YYY to the healthcare system.Half of hip fracture patients sustain a fragility fracture of the wrist, shoulder, humerus, hip or other skeletal sites in the months or years prior to breaking their hipPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsYWdoZXI8L0F1dGhvcj48WWVhcj4xOTgwPC9ZZWFy
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ADDIN EN.CITE.DATA 8 and deliver cost-savings ADDIN EN.CITE <EndNote><Cite><Author>Major</Author><Year>2019</Year><RecNum>678</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>678</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1548724077" guid="48717e4f-5342-4452-9f7b-33a35a68fa91">678</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Major, G.</author><author>Ling, R.</author><author>Searles, A.</author><author>Niddrie, F.</author><author>Kelly, A.</author><author>Holliday, E.</author><author>Attia, J.</author><author>Bogduk, N.</author></authors></contributors><auth-address>Bone and Joint Centre John Hunter Hospital New Lambton Australia.
University of Newcastle Faculty of Health and Medicine Callaghan Australia.
Hunter Medical Research Institute (HMRI) New Lambton Heights Australia.
Canberra Hospital Rheumatology Department Woden Australia.</auth-address><titles><title>The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service</title><secondary-title>JBMR Plus</secondary-title></titles><periodical><full-title>JBMR Plus</full-title></periodical><pages>56-63</pages><volume>3</volume><number>1</number><edition>2019/01/27</edition><keywords><keyword>Fracture liaison clinic</keyword><keyword>Fragility fracture</keyword><keyword>Health economics</keyword><keyword>Osteoporosis</keyword><keyword>Refracture</keyword></keywords><dates><year>2019</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>2473-4039 (Electronic)
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ADDIN EN.CITE.DATA 24.The organization of the FLS model of care proposed in this business plan has been informed by published studies of high-performing FLS and is adherent with widely endorsed internationalPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ba2Vzc29uPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA 31-34 Clinical Standards for FLS.Note to authors: It is recommended that authors include a summary of the section of the business plan titled Budgetary impact of a Fracture Liaison Service in [insert hospital name].This business plan describes why a FLS is required at [insert hospital name], how the FLS will be organized to deliver world class care, and what benefits the FLS will deliver in terms of improved patient management, reduced secondary fracture incidence and reduced healthcare costs.The need for a Fracture Liaison Service in [insert hospital name]The ageing populationIn 2017, the United Nations World Population Prospects noted that the world population had reached 7.6 billion people ADDIN EN.CITE <EndNote><Cite><Author>United Nations Department of Economic and Social Affairs Population Division</Author><Year>2017</Year><RecNum>570</RecNum><DisplayText><style face="superscript">35</style></DisplayText><record><rec-number>570</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1528254636" guid="a814f371-9391-4790-906b-1dc0b8dfeafb">570</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>United Nations Department of Economic and Social Affairs Population Division,</author></authors></contributors><titles><title>World Population Prospects: The 2017 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP.248.</title></titles><dates><year>2017</year></dates><pub-location>New York</pub-location><urls></urls><research-notes>Global population</research-notes></record></Cite></EndNote>35. Globally, while currently there are twice as many children aged <15 years as adults aged ≥60 years, the age structure of the population is set to shift dramatically in the coming decades. In [insert your country], the pace and extent of this shift can be illustrated by consideration of the projected changes in old-age dependency ratios. The old-age dependency ratio is the ratio of the population aged ≥65 years to the population aged 15–64 years, who are considered to be of “working age.” These ratios are presented as the number of dependents per 100 persons of working age.Note to business plan authors: Consider constructing a figure to illustrate the old-age dependency ratios for your country. These can be obtained for the period 1950 to 2100 from the United Nations document titled “World Population Prospects: Volume II: Demographic Profiles 2017 Revision. ST/ESA/SER.A/400” by Department of Economic and Social Affairs, Population Division, ?2017 United Nations available for download from: the event that you create a figure based on this information, seek permission to do so from:United Nations Department of Global Communications, 405 East 42nd Street, S-09FW001, New York, NY 10017, USA. Email request to permissions@ 94614927051000An example for Thailand is shown below.From World Population Prospects: Volume II: Demographic Profiles 2017 Revision. ST/ESA/SER.A/400, by Department of Economic and Social Affairs, Population Division, ?2017 United Nations. Reprinted with the permission of the United Nations.Hip fractures impose a significant burden on patients and [insert hospital name]Hip fractures are often considered the most debilitating fragility fracture, for good reason:Less than 50% of people who survive a hip fracture will walk unaided againPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pc25lczwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 36 and in many cases they will never regain their former degree of mobility ADDIN EN.CITE <EndNote><Cite><Author>Magaziner</Author><Year>1990</Year><RecNum>211</RecNum><DisplayText><style face="superscript">37</style></DisplayText><record><rec-number>211</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1489106943" guid="e6abf77e-f000-4434-89e2-323f3216d359">211</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Magaziner, J.</author><author>Simonsick, E. M.</author><author>Kashner, T. M.</author><author>Hebel, J. R.</author><author>Kenzora, J. E.</author></authors></contributors><auth-address>University of Maryland School of Medicine.</auth-address><titles><title>Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study</title><secondary-title>J Gerontol</secondary-title></titles><periodical><full-title>J Gerontol</full-title></periodical><pages>M101-7</pages><volume>45</volume><number>3</number><edition>1990/05/01</edition><keywords><keyword>*Activities of Daily Living</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Female</keyword><keyword>Geriatric Assessment</keyword><keyword>Hip Fractures/complications/*physiopathology/surgery</keyword><keyword>Humans</keyword><keyword>Locomotion</keyword><keyword>Male</keyword><keyword>Patient Discharge</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword><keyword>Social Support</keyword></keywords><dates><year>1990</year><pub-dates><date>May</date></pub-dates></dates><isbn>0022-1422 (Print)
0022-1422 (Linking)</isbn><accession-num>2335719</accession-num><urls><related-urls><url> costs: Hip fracture</research-notes></record></Cite></EndNote>37.A year after hip fracture, 60% of survivors require assistance with activities such as feeding, dressing or toileting, and 80% need help with activities such as shopping or driving ADDIN EN.CITE <EndNote><Cite><Author>Cooper</Author><Year>1997</Year><RecNum>212</RecNum><DisplayText><style face="superscript">38</style></DisplayText><record><rec-number>212</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1489107107" guid="22e606e0-f88e-4412-96a6-d4985884b189">212</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cooper, C.</author></authors></contributors><auth-address>M.R.C. Environmental Epidemiology Unit, University of Southampton, United Kingdom.</auth-address><titles><title>The crippling consequences of fractures and their impact on quality of life</title><secondary-title>Am J Med</secondary-title></titles><periodical><full-title>Am J Med</full-title></periodical><pages>12S-17S; discussion 17S-19S</pages><volume>103</volume><number>2A</number><edition>1997/08/18</edition><keywords><keyword>*Disabled Persons</keyword><keyword>Female</keyword><keyword>Fractures, Bone/*complications/mortality</keyword><keyword>Hip Fractures/complications</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>*Quality of Life</keyword><keyword>Risk</keyword><keyword>Spinal Fractures/complications</keyword><keyword>United Kingdom/epidemiology</keyword><keyword>United States/epidemiology</keyword></keywords><dates><year>1997</year><pub-dates><date>Aug 18</date></pub-dates></dates><isbn>0002-9343 (Print)
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ADDIN EN.CITE.DATA 39-41.Note to business plan authors: It is suggested that authors include information on the annual incidence of hip fracture in their country here, in addition to the number of individuals who present to their hospital. Further, information on the costs that hip fractures impose on the healthcare system could be included here.An obvious opportunity for intervention: Half of hip fracture patients sustain prior fracturesWhile some younger individuals develop osteoporosis and sustain fragility fractures, the majority of the disease burden is imposed upon people aged 50 years and over. Figure 1 overleaf provides an illustration of the sequence of fractures that a person living with osteoporosis may experience after their 50th birthday.Individuals who have sustained a fragility fracture are at considerably increased risk of sustaining subsequent fractures. Meta-analyses have established that a history of fracture at any skeletal site is associated with approximately a doubling of future fracture riskPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYW5pczwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 42, 43. Further, subsequent fractures appear to occur rapidly after an index fracture. In 2004, Swedish investigators examined the pattern of fracture risk following a prior fracture at the spine, shoulder or hip ADDIN EN.CITE <EndNote><Cite><Author>Johnell</Author><Year>2004</Year><RecNum>369</RecNum><DisplayText><style face="superscript">44</style></DisplayText><record><rec-number>369</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500613955" guid="4a96b4e0-e3a0-42f2-bc10-048a7de5d926">369</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Johnell, O.</author><author>Kanis, J. A.</author><author>Oden, A.</author><author>Sernbo, I.</author><author>Redlund-Johnell, I.</author><author>Petterson, C.</author><author>De Laet, C.</author><author>Jonsson, B.</author></authors></contributors><auth-address>Department of Orthopaedics, Malmo University Hospital, Malmo, Sweden.</auth-address><titles><title>Fracture risk following an osteoporotic fracture</title><secondary-title>Osteoporos Int</secondary-title></titles><periodical><full-title>Osteoporos Int</full-title></periodical><pages>175-9</pages><volume>15</volume><number>3</number><edition>2003/12/24</edition><keywords><keyword>Age Factors</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Fractures, Bone/*etiology</keyword><keyword>Hip Fractures/etiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Osteoporosis/*complications</keyword><keyword>Poisson Distribution</keyword><keyword>Recurrence</keyword><keyword>Risk Factors</keyword><keyword>Shoulder Fractures/etiology</keyword><keyword>Spinal Fractures/etiology</keyword></keywords><dates><year>2004</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0937-941X (Print)
0937-941X (Linking)</isbn><accession-num>14691617</accession-num><urls><related-urls><url> factors: Prior fracture</research-notes></record></Cite></EndNote>44. During five years of follow-up, one third of all subsequent fractures occurred within the first year after fracture, and less than 9% of all subsequent fractures occurred in the fifth year. More recently, several studies have demonstrated that secondary fracture risk is highest during the two years following an index fracture, which has been characterised as the period of “imminent fracture risk”PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Xb25nPC9BdXRob3I+PFllYXI+MjAxOTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 45-47.From the obverse perspective, several studies have noted that up to half of hip fracture patients sustained fractures at other skeletal sites during the months and years before breaking their hip. This was first reported by US investigators in 1980 ADDIN EN.CITE <EndNote><Cite><Author>Gallagher</Author><Year>1980</Year><RecNum>370</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>370</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500614412" guid="fa20b870-a79e-4c4b-aef6-ea526ebbb9d5">370</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gallagher, J. C.</author><author>Melton, L. J.</author><author>Riggs, B. L.</author><author>Bergstrath, E.</author></authors></contributors><titles><title>Epidemiology of fractures of the proximal femur in Rochester, Minnesota</title><secondary-title>Clin Orthop Relat Res</secondary-title></titles><periodical><full-title>Clin Orthop Relat Res</full-title></periodical><pages>163-71</pages><number>150</number><edition>1980/07/01</edition><keywords><keyword>Adult</keyword><keyword>Age Factors</keyword><keyword>Aged</keyword><keyword>Colles' Fracture/complications</keyword><keyword>Female</keyword><keyword>Femoral Neck Fractures/*epidemiology</keyword><keyword>Fractures, Bone/complications</keyword><keyword>Hip Fractures/complications/*epidemiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Minnesota</keyword><keyword>Mortality</keyword><keyword>Rib Fractures/complications</keyword><keyword>Sex Factors</keyword><keyword>Spinal Injuries/complications</keyword></keywords><dates><year>1980</year><pub-dates><date>Jul-Aug</date></pub-dates></dates><isbn>0009-921X (Print)
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ADDIN EN.CITE.DATA 2, Scotland ADDIN EN.CITE <EndNote><Cite><Author>McLellan</Author><Year>2004</Year><RecNum>373</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>373</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500861655" guid="3d26cfdd-f693-4547-b8cc-376b07778867">373</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>McLellan, AR</author><author>Reid, DM</author><author>Forbes, K </author><author>Reid, R</author><author>Campbell, C</author><author>Gregori, A</author><author>Raby, N</author><author>Simpson, A</author></authors></contributors><titles><title>Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland (CEPS 99/03)</title></titles><dates><year>2004</year></dates><publisher>NHS Quality Improvement Scotland</publisher><urls><related-urls><url> gap: National - Scotland</research-notes></record></Cite></EndNote>3 and the USA ADDIN EN.CITE <EndNote><Cite><Author>Edwards</Author><Year>2007</Year><RecNum>374</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>374</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500861794" guid="21ae2712-7231-483e-8cd3-95b9bfa76a53">374</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Edwards, B. J.</author><author>Bunta, A. D.</author><author>Simonelli, C.</author><author>Bolander, M.</author><author>Fitzpatrick, L. A.</author></authors></contributors><auth-address>Northwestern University, Chicago, IL, USA.</auth-address><titles><title>Prior fractures are common in patients with subsequent hip fractures</title><secondary-title>Clin Orthop Relat Res</secondary-title><alt-title>Clinical orthopaedics and related research</alt-title></titles><periodical><full-title>Clin Orthop Relat Res</full-title></periodical><pages>226-30</pages><volume>461</volume><edition>2007/04/07</edition><keywords><keyword>Accidental Falls</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Cost-Benefit Analysis</keyword><keyword>Female</keyword><keyword>Fractures, Bone/*epidemiology</keyword><keyword>Hip Fractures/economics/*epidemiology</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Male</keyword><keyword>Osteoporosis/drug therapy/economics/epidemiology</keyword><keyword>Risk Factors</keyword><keyword>United States</keyword></keywords><dates><year>2007</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0009-921X (Print)
0009-921X (Linking)</isbn><accession-num>17415014</accession-num><work-type>Multicenter Study
Research Support, Non-U.S. Gov't</work-type><urls><related-urls><url> factors: Prior fracture</research-notes><language>eng</language></record></Cite></EndNote>4. In this regard, the Australian group coined the term “signal fracture” to highlight the opportunity presented when individuals seek medical attention at a hospital or community-based fracture clinic.Figure 1. Fracture and morbidity for an individual with osteoporosis (adapted from The care of patients with fragility fracture ADDIN EN.CITE <EndNote><Cite><Author>British Orthopaedic Association</Author><Year>2007</Year><RecNum>175</RecNum><DisplayText><style face="superscript">21</style></DisplayText><record><rec-number>175</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1487282424" guid="773715d1-907d-4a35-b615-032c1eb8f95e">175</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>British Orthopaedic Association,</author><author>British Geriatrics Society,</author></authors></contributors><titles><title>The care of patients with fragility fracture</title></titles><edition>2nd</edition><dates><year>2007</year></dates><urls><related-urls><url> Standards: UK</research-notes><access-date>21-07-2011</access-date></record></Cite></EndNote>21)The impact of osteoporosis treatment on secondary fracture incidenceNote to business plan authors: It would be appropriate to make reference to relevant national/regional osteoporosis clinical guidelines at the beginning of this section. In these guidelines - and many other guidelines published throughout the world - individuals who have sustained fragility fractures are routinely identified as a priority group for osteoporosis assessment and treatment, where warranted.The 2016 International Osteoporosis Foundation (IOF) World Osteoporosis Day Report and an associated narrative review article in Osteoporosis International provided commentary on the evidence-base for osteoporosis treatments specifically in the context of secondary fracture prevention. Authors might consider commenting upon these publications to describe the impact osteoporosis treatments available in their countries have upon secondary fracture incidence. See:Gaps and solutions in bone health: A global framework for improvement. Harvey, NC and McCloskey EV. Nyons: International Osteoporosis Foundation, 2016. ADDIN EN.CITE <EndNote><Cite><Author>Harvey</Author><Year>2016</Year><RecNum>137</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>137</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1487042939" guid="79b08fa4-a344-4a12-943d-14e6795ab8e7">137</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Harvey, N.C.</author><author>McCloskey, E.V.</author></authors><secondary-authors><author>Misteli, L.</author><author>Laverty, C.</author><author>Stenmark, J.</author></secondary-authors></contributors><titles><title>Gaps and solutions in bone health: A global framework for improvement</title><secondary-title>World Osteoporosis Day Thematic Report</secondary-title></titles><dates><year>2016</year></dates><pub-location>Nyon.</pub-location><publisher>International Osteoporosis Foundation</publisher><urls></urls><research-notes>WOD Report: 2016</research-notes></record></Cite></EndNote>5Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Harvey NC et al. Osteoporos Int. 2017 May;28(5):1507-1529.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYXJ2ZXk8L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 6Secondary fracture prevention: A global, regional, national and local care gapThe 2019 IOF Compendium of Osteoporosis documented a persistent and pervasive care gap in the secondary prevention of fragility fractures throughout the world ADDIN EN.CITE <EndNote><Cite><Author>Cooper</Author><Year>2019</Year><RecNum>1012</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>1012</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1592365003" guid="47e6a3ef-4008-4aca-87b7-cd32f87d5b4c">1012</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Cooper, C.</author><author>Ferrari, S.</author></authors><secondary-authors><author>Mitchell, P.J.</author><author>Harvey, N.</author><author>Dennison, E.</author></secondary-authors></contributors><titles><title>IOF Compendium of Osteoporosis</title></titles><edition>2nd</edition><dates><year>2019</year></dates><pub-location>Nyons</pub-location><publisher>International Osteoporosis Foundation</publisher><urls><related-urls><url> Compendium of Osteoporosis</research-notes></record></Cite></EndNote>7.Note to business plan authors: The authors may want to include relevant studies from their country.Current standards of secondary preventive care in [insert hospital name]Note to business plan authors: The authors should include local data on the provision of secondary preventive care for individuals who present to their hospital with a fragility fracture.Fracture Liaison Services: A proven healthcare delivery solutionDefinition of a high-performing Fracture Liaison ServiceA Fracture Liaison Service (FLS, also known as a Secondary Fracture Prevention [SFP] Program in some countries) is a system to ensure fracture risk assessment, and treatment where appropriate, is delivered to all patients with fragility fractures. A FLS is usually comprised of a dedicated case worker, often a clinical nurse specialist, who works to pre-agreed protocols to case-find and assess fracture patients. While FLS are usually based in hospital, some primary care based FLS have been developedPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcmFua2luPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48
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ADDIN EN.CITE.DATA 50. Authors could provide a summary of FLS relevant to their country based on this analysis or of FLS represented on the IOF Map of Best Practice described below ADDIN EN.CITE <EndNote><Cite><Author>International Osteoporosis Foundation</Author><Year>2019</Year><RecNum>366</RecNum><DisplayText><style face="superscript">51</style></DisplayText><record><rec-number>366</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1498776544" guid="0030d0fe-5fb2-4e19-943a-1d269af3c1e9">366</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>International Osteoporosis Foundation,</author></authors></contributors><titles><title>IOF Capture the Fracture?: Map of Best Practice </title></titles><number>21 February 2019</number><dates><year>2019</year></dates><pub-location>Nyons</pub-location><urls><related-urls><url>: Capture the Fracture</research-notes></record></Cite></EndNote>51. Authors could also make reference to well-established and well documented FLS such as those described in the publications below:Australia: Royal Newcastle Centre and John Hunter HospitalA team approach: implementing a model of care for preventing osteoporosis related fractures. Giles M et al. Osteoporosis International 2011 Aug;22(8):2321-2328PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWxlczwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 52.The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service. Major G et al. Journal of Bone and Mineral Research Plus. 2018 Apr 18;3(1):56-63 ADDIN EN.CITE <EndNote><Cite><Author>Major</Author><Year>2019</Year><RecNum>678</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>678</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1548724077" guid="48717e4f-5342-4452-9f7b-33a35a68fa91">678</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Major, G.</author><author>Ling, R.</author><author>Searles, A.</author><author>Niddrie, F.</author><author>Kelly, A.</author><author>Holliday, E.</author><author>Attia, J.</author><author>Bogduk, N.</author></authors></contributors><auth-address>Bone and Joint Centre John Hunter Hospital New Lambton Australia.
University of Newcastle Faculty of Health and Medicine Callaghan Australia.
Hunter Medical Research Institute (HMRI) New Lambton Heights Australia.
Canberra Hospital Rheumatology Department Woden Australia.</auth-address><titles><title>The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service</title><secondary-title>JBMR Plus</secondary-title></titles><periodical><full-title>JBMR Plus</full-title></periodical><pages>56-63</pages><volume>3</volume><number>1</number><edition>2019/01/27</edition><keywords><keyword>Fracture liaison clinic</keyword><keyword>Fragility fracture</keyword><keyword>Health economics</keyword><keyword>Osteoporosis</keyword><keyword>Refracture</keyword></keywords><dates><year>2019</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>2473-4039 (Electronic)
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ADDIN EN.CITE.DATA 55.Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. McLellan AR et al. Osteoporosis International 2011 Jul;22(7):2083-2098PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY0xlbGxhbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+
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ADDIN EN.CITE.DATA 56.USA: Kaiser Permanente Healthy Bones ProgramOsteoporosis disease management: the role of the orthopaedic surgeon. Dell RM et al. Journal of Bone and Joint Surgery (Am) 2008 Nov;90 Suppl 4:188-94 ADDIN EN.CITE <EndNote><Cite><Author>Dell</Author><Year>2008</Year><RecNum>179</RecNum><DisplayText><style face="superscript">57</style></DisplayText><record><rec-number>179</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1487290230" guid="3493dc38-f08a-4900-861d-57415b973c5f">179</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dell, R.</author><author>Greene, D.</author><author>Schelkun, S. R.</author><author>Williams, K.</author></authors></contributors><auth-address>Richard.M.Dell@</auth-address><titles><title>Osteoporosis disease management: the role of the orthopaedic surgeon</title><secondary-title>J Bone Joint Surg Am</secondary-title></titles><periodical><full-title>J Bone Joint Surg Am</full-title></periodical><pages>188-94</pages><volume>90 Suppl 4</volume><edition>2008/11/15</edition><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Female</keyword><keyword>Fractures, Spontaneous/prevention & control</keyword><keyword>Hip Fractures/diagnosis/*prevention & control</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Orthopedics</keyword><keyword>Osteoporosis/*complications</keyword><keyword>Patient Education as Topic</keyword><keyword>Prospective Studies</keyword><keyword>Role</keyword></keywords><dates><year>2008</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1535-1386 (Electronic)
0021-9355 (Linking)</isbn><accession-num>18984730</accession-num><urls><related-urls><url> & PFP: Kaiser Permanente</research-notes></record></Cite></EndNote>57.Osteoporosis disease management: What every orthopaedic surgeon should know. Dell RM et al. Journal of Bone and Joint Surgery (Am) 2009 Nov;91 Suppl 6:79-86 ADDIN EN.CITE <EndNote><Cite><Author>Dell</Author><Year>2009</Year><RecNum>395</RecNum><DisplayText><style face="superscript">58</style></DisplayText><record><rec-number>395</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500943881" guid="12c3ecbd-066f-4d68-b4c3-b203d98f4249">395</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dell, R. M.</author><author>Greene, D.</author><author>Anderson, D.</author><author>Williams, K.</author></authors></contributors><auth-address>Kaiser Downey, CA 90242, USA. Richard.M.Dell@</auth-address><titles><title>Osteoporosis disease management: What every orthopaedic surgeon should know</title><secondary-title>J Bone Joint Surg Am</secondary-title><alt-title>The Journal of bone and joint surgery. American volume</alt-title></titles><periodical><full-title>J Bone Joint Surg Am</full-title></periodical><pages>79-86</pages><volume>91 Suppl 6</volume><edition>2009/11/26</edition><keywords><keyword>Absorptiometry, Photon</keyword><keyword>Bone Remodeling</keyword><keyword>*Disease Management</keyword><keyword>Female</keyword><keyword>Fractures, Spontaneous/etiology/prevention & control/*therapy</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Osteoporosis/diagnosis/physiopathology/*therapy</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1535-1386 (Electronic)
0021-9355 (Linking)</isbn><accession-num>19884415</accession-num><work-type>Clinical Trial</work-type><urls><related-urls><url>: USA</research-notes><language>eng</language></record></Cite></EndNote>58.Benchmarking performance: Clinical Standards for Fracture Liaison ServicesNote to business plan authors: Internationally endorsed Clinical Standards for FLS have been published by IOF as a component of the IOF Capture the Fracture? Program. Details of the Capture the Fracture? Program and the associated Best Practice Framework follow. National Clinical Standards for FLS have also been published in Canada, Japan, New Zealand and the UK. Summaries of these documents is also provided for the authors’ reference.In 2012, the International Osteoporosis Foundation (IOF) launched the Capture the Fracture? Program with publication of the 2012 World Osteoporosis Day thematic report ADDIN EN.CITE <EndNote><Cite><Author>Akesson</Author><Year>2012</Year><RecNum>133</RecNum><DisplayText><style face="superscript">59</style></DisplayText><record><rec-number>133</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1487042309" guid="961e3d8b-b5ac-4fd8-ba99-3d8bc9c43fca">133</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Akesson, K.</author><author>Mitchell, P.J.</author></authors><secondary-authors><author>Stenmark, J.</author><author>Misteli, L.</author></secondary-authors></contributors><titles><title>Capture the Fracture: A global campaign to break the fragility fracture cycle</title><secondary-title>World Osteoporosis Day Thematic Report</secondary-title></titles><dates><year>2012</year></dates><pub-location>Nyon.</pub-location><publisher>International Osteoporosis Foundation</publisher><urls><related-urls><url> Report: 2012</research-notes></record></Cite></EndNote>59. Since 2012, Capture the Fracture? has developed into one of IOF’s leading initiatives. The key components of Capture the Fracture? are: Website: The Capture the Fracture? website - capture-the- - provides a comprehensive suite of resources to support healthcare professionals and administrators to establish a new FLS or improve an existing FLS.Webinars: An ongoing series of webinars provide an opportunity to learn from experts across the globe who have established high-performing FLS and contributed to development of guidelines and policy on secondary fracture prevention. As of July 2017, webinars have been conducted in Chinese, Dutch, English, French, Italian, Japanese, Polish, Portuguese, Spanish and Thai.Best Practice Framework: The Best Practice Framework (BPF), which is currently available in nine major languages, sets an international benchmark for FLS by defining essential and aspirational elements of service delivery. The BPF serves as the measurement tool for IOF to award Capture the Fracture? Best Practice Recognition status. The 13 globally-endorsed standards of the BPF were published in Osteoporosis International in 2013PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ba2Vzc29uPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA 30.Patient-level key performance indicator set: Developed in collaboration with the FFN Special Interest Group on Secondary Fragility Fracture Prevention and the National Osteoporosis Foundation (USA), the Capture the Fracture? Working Group adapted existing metrics from the UK-based FLS Database ADDIN EN.CITE <EndNote><Cite><Author>Royal College of Physicians</Author><Year>2020</Year><RecNum>469</RecNum><DisplayText><style face="superscript">60</style></DisplayText><record><rec-number>469</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1502404345" guid="30714f27-c538-483d-9454-92ec493b133a">469</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Royal College of Physicians,</author></authors></contributors><titles><title>Fracture Liaison Service Database (FLS-DB)</title></titles><number>13 July 2020</number><dates><year>2020</year></dates><pub-location>London</pub-location><urls><related-urls><url> Registry: UK</research-notes></record></Cite></EndNote>60 to develop a patient-level Key Performance Indicator (KPI) set for FLSPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYXZhaWQ8L0F1dGhvcj48WWVhcj4yMDIwPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 61.National Clinical Standards for FLS have also been published by national osteoporosis societies in Canada ADDIN EN.CITE <EndNote><Cite><Author>Osteoporosis Canada</Author><Year>2014</Year><RecNum>298</RecNum><DisplayText><style face="superscript">31</style></DisplayText><record><rec-number>298</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1492057011" guid="26696bd5-45f8-4edf-8799-d2685a412499">298</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Osteoporosis Canada,</author></authors></contributors><titles><title>Quality Standards for Fracture Liaison Services in Canada</title></titles><dates><year>2014</year></dates><pub-location>Toronto</pub-location><publisher>Osteoporosis Canada</publisher><urls><related-urls><url>: Canada</research-notes><access-date>13 April 2017</access-date></record></Cite></EndNote>31, Japan ADDIN EN.CITE <EndNote><Cite><Author>Arai</Author><Year>2019</Year><RecNum>1020</RecNum><DisplayText><style face="superscript">32</style></DisplayText><record><rec-number>1020</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1592450517" guid="f18ebbf2-a5b1-47c4-a1ac-274bcffa6a3f">1020</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Arai, H.</author><author>Ikeda, S.</author><author>Okuro, M.</author><author>Kurokawa, M.</author><author>Sakai, A.</author><author>Sawaguchi, T.</author><author>Suzuki, A.</author><author>Soen, S.</author><author>Nakatoh, S.</author><author>Hagino, H.</author><author>Matsushita. T.</author><author>Yamamoto, M.</author></authors></contributors><titles><title>Clinical Standards for Fracture Liaison Services (FLS) in Japan</title></titles><dates><year>2019</year></dates><pub-location>Tokyo</pub-location><publisher>Japan Osteoporosis Society and FFN Japan</publisher><urls><related-urls><url>: Clinical Standards - Japan</research-notes></record></Cite></EndNote>32, New Zealand ADDIN EN.CITE <EndNote><Cite><Author>Osteoporosis New Zealand</Author><Year>2016</Year><RecNum>300</RecNum><DisplayText><style face="superscript">62</style></DisplayText><record><rec-number>300</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1492057090">300</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Osteoporosis New Zealand,</author></authors></contributors><titles><title>Clinical Standards for Fracture Liaison Services in New Zealand</title></titles><dates><year>2016</year></dates><pub-location>Wellington</pub-location><publisher>Osteoporosis New Zealand</publisher><urls><related-urls><url>: New Zealand</research-notes><access-date>13 April 2017</access-date></record></Cite></EndNote>62 and UK ADDIN EN.CITE <EndNote><Cite><Author>Gallacher</Author><Year>2019</Year><RecNum>1019</RecNum><DisplayText><style face="superscript">34</style></DisplayText><record><rec-number>1019</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1592449752" guid="536122dc-8de6-4662-b0ef-128c2782b473">1019</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Gallacher, S.J.</author><author>Alexander, S.</author><author>Beswetherick, N.</author><author>Carr, A.</author><author>Durber, A.</author><author>Gittoes, N.</author><author>Gray, A.</author><author>Javaid, K.</author><author>Kendrick, D.</author><author>Lindsey, J.</author><author>Ong, T.</author><author>Smith, A.</author><author>Stone, M.</author><author>Tanna, N.</author><author>Thurston, A.</author><author>Wardell, F.</author></authors></contributors><titles><title>Effective Secondary Prevention of Fragility Fractures: Clinical Standards for Fracture Liaison Services</title></titles><dates><year>2019</year></dates><pub-location>Camerton</pub-location><publisher>Royal Osteoporosis Society</publisher><urls><related-urls><url>: Clinical Standards - UK</research-notes></record></Cite></EndNote>34. These standards are based upon the 5IQ framework (i.e. standards relating to identification, investigation, information, initiation, integration and quality).Note to business plan authors: As described in the FFN Clinical Toolkit, the IOF Capture the Fracture? Partnership launched in 2020 is developing a comprehensive suite of new resources to support development and improvement of FLS worldwide. Read more at:. Endorsement of the Fracture Liaison Service model of careNote to business plan authors: The FLS model of care has been widely endorsed and advocated for in many countries throughout the world. The authors may consider that highlighting this widespread endorsement to the intended recipients of their business plan may provide helpful perspective for the administrators who will evaluate the business plan.The FLS model of care has been endorsed and advocated for by governments, healthcare professional organisations and national osteoporosis societies, and national alliances comprised of these and other groups. Examples from several countries include:Australia: New South Wales Agency for Clinical Innovation ADDIN EN.CITE <EndNote><Cite><Author>New South Wales Agency for Clinical Innovation</Author><Year>2020</Year><RecNum>396</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>396</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500945476" guid="c5762df9-b22e-4158-9189-d6a13903f289">396</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>New South Wales Agency for Clinical Innovation,</author></authors></contributors><titles><title>Osteoporosis Refracture Prevention</title></titles><number>15 July 2020</number><dates><year>2020</year></dates><urls><related-urls><url>: Australia</research-notes></record></Cite></EndNote>10, Department of Health in Western Australia ADDIN EN.CITE <EndNote><Cite><Author>Government of Western Australia</Author><Year>2011</Year><RecNum>397</RecNum><DisplayText><style face="superscript">11</style></DisplayText><record><rec-number>397</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500945727" guid="da786208-f8f0-4395-9499-442d38decdd0">397</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of Western Australia,</author></authors><secondary-authors><author>Department of Health Musculoskeletal Diabetes & Endocrine Falls Prevention and Aged Care Health Networks (WA),</author></secondary-authors></contributors><titles><title>Osteoporosis Model of Care</title></titles><dates><year>2011</year></dates><pub-location>Perth</pub-location><urls><related-urls><url>: Australia</research-notes><access-date>20 March 2012</access-date></record></Cite></EndNote>11 and the SOS Fracture Alliance ADDIN EN.CITE <EndNote><Cite><Author>SOS Fracture Alliance</Author><Year>2020</Year><RecNum>398</RecNum><DisplayText><style face="superscript">29</style></DisplayText><record><rec-number>398</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500946241" guid="c237f527-8fca-4796-a54c-80c8246aec29">398</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>SOS Fracture Alliance,</author></authors></contributors><titles><title>SOS Fracture Alliance: Making the first break the last</title></titles><number>12 July 2020</number><dates><year>2020</year></dates><urls><related-urls><url>: National alliance</research-notes></record></Cite></EndNote>29.Canada: Ontario Osteoporosis Strategy ADDIN EN.CITE <EndNote><Cite><Author>Osteoporosis Canada</Author><Year>2020</Year><RecNum>399</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>399</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500947415" guid="50c8cf4e-f279-4a11-bfea-7d37747bcaec">399</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Osteoporosis Canada,</author><author>Ontario Ministry of Health and Long Term Care,</author><author>McMaster University,</author><author>Women's College Hospital,</author><author>St. Michael's Hospital,</author><author>Ontario College of Family Physicians,</author></authors></contributors><titles><title>Ontario Osteoporosis Strategy</title></titles><number>15 July 2020</number><dates><year>2020</year></dates><urls><related-urls><url>: Canada</research-notes></record></Cite></EndNote>12 and Osteoporosis Canada ADDIN EN.CITE <EndNote><Cite><Author>Osteoporosis Canada</Author><Year>2013</Year><RecNum>361</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>361</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1498606254" guid="5c22d201-a392-496f-9366-fda63d836269">361</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Osteoporosis Canada,</author></authors></contributors><titles><title>Make the FIRST break the LAST with Fracture Liaison Services</title></titles><dates><year>2013</year></dates><urls><related-urls><url>: Canada</research-notes></record></Cite></EndNote>25.New Zealand: Live Stronger for Longer initiative ADDIN EN.CITE <EndNote><Cite><Author>Accident Compensation Corporation</Author><Year>2020</Year><RecNum>400</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>400</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1500947790" guid="484d5cbc-e3bb-4d8e-afd9-9bda5352e7c1">400</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Accident Compensation Corporation,</author><author>Ministry of Health,</author><author>Health Quality & 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ADDIN EN.CITE.DATA 24.Note to business plan authors: See the publication for the 81 organisations who endorsed the CtA prior to publication and contact the FFN for information on the 50 organisations who have endorsed the CtA since publication (Email: CtA@ff-). Implementation of a Fracture Liaison Service in [insert hospital name]This business plan makes the case for commissioning of a Fracture Liaison Service (FLS) in [insert name of hospital], structured according to the internationally recognized Clinical Standards for FLS described previously, to reduce the incidence of hip fracture amongst our older people.Aim: The aim of the proposed FLS is to ensure that all patients aged [XX] years and over who present to [insert hospital name] with fragility fractures receive assessment and, where warranted, pharmacological treatment for osteoporosis, and referral to local falls prevention services to reduce their risk of subsequent fractures.Current provision: Note to business plan authors: Summarise the local data on the provision of secondary preventive care for individuals who present to their hospital with a fragility fracture.FLS Service model: Note to business plan authors: Include a detailed description of how the FLS will be organized and what interventions will be offered to fracture patients. A patient pathway map through the FLS provides administrators with a clear overview of how the FLS will function. Further, quantification of the proportion of all fragility fracture patients who will undergo investigations, receive osteoporosis treatment and be referred into falls prevention programs provides an opportunity to illustrate how the FLS will significantly improve quality of care as compared to baseline levels.Budgetary impact of a Fracture Liaison Service in [insert hospital name]Note to business plan authors: Successful business plans describe very clearly the costs and benefits of the intended new service. Business plan authors could consider cost-effectiveness publications from the following FLS to inform their modelling.Australia: The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service. Major G et al. Journal of Bone and Mineral Research Plus. 2018 Apr 18;3(1):56-63 ADDIN EN.CITE <EndNote><Cite><Author>Major</Author><Year>2019</Year><RecNum>678</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>678</rec-number><foreign-keys><key app="EN" db-id="z0z0ptdx5dtrvyed5ruxree4vtp0xv5fxtf2" timestamp="1548724077" guid="48717e4f-5342-4452-9f7b-33a35a68fa91">678</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Major, G.</author><author>Ling, R.</author><author>Searles, A.</author><author>Niddrie, F.</author><author>Kelly, A.</author><author>Holliday, E.</author><author>Attia, J.</author><author>Bogduk, N.</author></authors></contributors><auth-address>Bone and Joint Centre John Hunter Hospital New Lambton Australia.
University of Newcastle Faculty of Health and Medicine Callaghan Australia.
Hunter Medical Research Institute (HMRI) New Lambton Heights Australia.
Canberra Hospital Rheumatology Department Woden Australia.</auth-address><titles><title>The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service</title><secondary-title>JBMR Plus</secondary-title></titles><periodical><full-title>JBMR Plus</full-title></periodical><pages>56-63</pages><volume>3</volume><number>1</number><edition>2019/01/27</edition><keywords><keyword>Fracture liaison clinic</keyword><keyword>Fragility fracture</keyword><keyword>Health economics</keyword><keyword>Osteoporosis</keyword><keyword>Refracture</keyword></keywords><dates><year>2019</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>2473-4039 (Electronic)
2473-4039 (Linking)</isbn><accession-num>30680364</accession-num><urls><related-urls><url>: Australia</research-notes></record></Cite></EndNote>9.Canada: Cost-effectiveness of a fracture liaison service--a real-world evaluation after 6 years of service provision. Hoch JS et al. Osteoporosis International 2016 Jan;27(1):231-240PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Zb25nPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 65.Japan: Economic evaluation of osteoporosis liaison service for secondary fracture prevention in postmenopausal osteoporosis patients with previous hip fracture in Japan. Moriwaki K and Noto S. Osteoporosis International 2017 Feb;28(2):621-632PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb3Jpd2FraTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+
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ADDIN EN.CITE.DATA 66.UK: Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. McLellan AR et al. Osteoporosis International 2011 Jul;22(7):2083-2098PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY0xlbGxhbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+
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ADDIN EN.CITE.DATA 67.Note to business plan authors: This section of the business plan should highlight the personnel and facilities that are required to implement a FLS, and their costs, which includes:A FLS Coordinator who is usually a nurse practitioner (NP), a registered nurse (RN) or a trainee physician.A senior Specialist Physician to serve as medical lead for the FLS.Administrative support to facilitate communication between the FLS and the patient, and in healthcare systems with established primary care, the patient’s Primary Care Provider (PCP).Development of existing IT systems or establishment of a bespoke FLS database to underpin communication with patients and healthcare professionals.Access to axial dual energy X-Ray absorptiometry (DXA) scanning.Access to laboratory testing.Establishment of referral mechanisms to local falls prevention clinics.Appropriate office space for FLS clinics to be held.This section of the business plan will be highly country and site specific. Local service configurations will significantly influence how the FLS is funded. Revenue modelling will be determined by the ratio of cost vs. reimbursement for specific elements of service provision.SummaryHip fractures exert a substantial toll on our local older people and the healthcare budgets. Half of hip fracture patients give us considerable advance notice that one day they will present to the local orthopaedic unit.Implementation of a FLS in [insert name of local healthcare economy] will close the secondary fracture prevention gap in our area. The FLS will improve the quality of care we give and reduce costs associated with preventable fragility fractures. This business plan recommends commissioning of this program as a matter of urgency.References ADDIN EN.REFLIST 1.Gallagher JC, Melton LJ, Riggs BL, Bergstrath E. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res. 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