Fracture Liaison Service in Queen Elizabeth Hospital – first year review

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Authors (including presenting author) :
Tam SM(1), Tiu KL(1), Lee KB(1), Tsang KK(1), Wong KI(1), Li W(1)
Affiliation :
(1)Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital
Introduction :
Fragility Hip Fracture (FHF) patients have 4 times higher risk to sustain a secondary hip fracture in the next 3 years, which resulted in poorer outcomes and increased mortality. An integrated FHF service and clinical pathway have been implemented in Orthopaedics and Traumatology (O&T) department since 2015, but secondary fracture prevention was not well addressed. Therefore, our department started a pilot secondary fracture prevention program on FHF patients in 2017. Concurrently, Fracture Liaison Service (FLS) was introduced by Hospital Authority to provide sustainable rehabilitation and secondary fracture prevention in patients with fragility fractures. Queen Elizabeth Hospital, being one of the three pioneer hospitals, adopted FLS in late 2017 for hip fracture service enhancement. Fracture Liaison Nurse (FLN) applies “3 I” protocol to FHF patients for osteoporosis screening and care. O&T surgeons assess and prescribe anti-osteoporotic treatment for eligible patients. FLS not only focus on prescription of anti-osteoporotic treatment but also reinforcing drug compliance and promoting rehabilitation. Multidisciplinary team (MDT) members provide education including bone health, nutrition, exercise and home safety. In addition, each discipline performs independent assessment to identify patients’ potential problem(s) and gives relevant advice. Effectiveness and complication of anti-osteoporotic treatment are closely monitored by portable DXA machine and phone follow-up. Patients are also called to remind drug compliance, fall prevention and lifestyle modification.
Objectives :
To evaluate Fracture Liaison Service after the first year of introduction
Methodology :
A retrospective review of all Fragility Hip Fracture admissions to Orthopaedics and Traumatology department in 2018
Result & Outcome :
800 FHF patients (age ranged from 65 to 103) were recruited in this review. All of them received osteoporosis screening and care. Among those 800 patients, 23.38% (187) were eligible to anti-osteoporotic treatment and 83.96% (157) of them have started the treatment. 91.67% (77/84) have 1-year follow-up in FLS clinic. All of them received MDT service and expressed satisfaction on such service by patient satisfactory survey. They all had good drug compliance and no complication of treatment. FLS provides sustainable rehabilitation and secondary fracture prevention in patients with fragility fractures. Although there was no significant evidence of decreasing secondary fracture in this first year report, we have demonstrated FLS is a feasible service model with encouraging results.

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