National Toolkits
Australia
FLS Toolkit
Fracture Liaison Service Resource Pack. Mitchell PJ and Jordan J. Novartis. 2012.
Government initiatives
Three Australian states have published documents that specifically relate to post-fracture care and FLS:
- New South Wales Model of Care for Osteoporotic Refracture Prevention. 2011. New South Wales Agency for Clinical Innovation.
- Models of Care for Orthopaedic Rehabilitation - Fragility Fractures General Orthopaedic Trauma and Arthroplasty. Statewide Orthopaedic Clinical Network and Rehabilitation Clinical Network. SA Health. 2011.
- Osteoporosis Model of Care. Musculoskeletal, Diabetes & Endocrine, Falls Prevention and Aged Care Health Networks. Department of Health, Western Australia. 2008.
Professional guidelines
Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. Royal Australian College of General Practitioners. 2010.
In 2013, an Australian and New Zealand Hip Fracture Registry is also in development.
Canada
Government initiatives
The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada. Jaglal SB, Hawker G, Cameron C, Canavan J, Beaton D, Bogoch E, Jain R, Papaioannou A; Osteoporosis Research, Monitoring and Evaluation Working Group. Osteoporos Int. 2010 Jun;21(6):903-908. PubMed ID 20309525
Professional guidelines
2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD; Scientific Advisory Council of Osteoporosis Canada. CMAJ. 2010 Nov 23;182(17):1864-1873. PubMed ID 20940232
Osteoporosis Canada
Osteoporosis Canada is leading a nationwide initiative to improve post-fracture care which includes:
- A White Paper - Towards a fracture free future - the focus of which is closing the secondary fracture prevention care gap across Canada
- An osteoporosis patient bill of rights supports the aims of the White Paper
- The FOCUS on Advocacy Forum which has led to specific action plans for every Canadian province to implement FLS models of care
France
The French association "Groupe de Recherche et d'Information sur les Ostéoporoses" (GRIO) has launched a workshop on Fracture Liaison Services (FLS) to promote their implementation in France. This meeting was organized for centers which already have an FLS or those who want to develop one. Its purpose was to share one another’s experiences in this area by discussing what works well and what has been problematic. The long term goal is to try to have a common resource for France where a maximum amount of information is gathered. The document summarizes the discussions and programme held during that day.
Low Osteoporosis Treatment Initiation Rate in Women after Distal Forearm or Proximal Humerus Fracture: A Healthcare Database Nested Cohort Study. Viprey M, Caillet P, Canat G, Jaglal S, Haesebaert J, Chapurlat R, Schott AM. PLoS One. 2015 Dec 2;10(12):e0143842. PubMed ID 26630534
National Societies in France:
- Association Française de Lutte Anti Rhumatisme (AFLAR)
- Research and Information Group on Osteoporosis (GRIO)
- Societé Française d'Ostéodensitométrie Clinique (SOFOC)
- Société Française de Chirurgie Orthopédique et Traumatologie (SOFCOT)
New Zealand
FLS Toolkit
Fracture Liaison Service Resource Pack. Mitchell PJ. 2014.
Osteoporosis New Zealand
BoneCare 2020: A systematic approach to hip fracture care and prevention for New Zealand. Osteoporosis New Zealand. 2012.
In 2013, an Australian and New Zealand Hip Fracture Registry is also in development.
United Kingdom
FLS Toolkit
Fracture Liaison Service Resource Pack. Mitchell PJ and Adekunle F. Novartis. 2010.
Government initiatives
The Department of Health in England developed policy describing a systematic approach to falls and fracture prevention which included:
- Falls and fractures: Effective interventions in health and social care. Department of Health. 2009.
- Fracture prevention services: An economic evaluation. Department of Health. 2009.
- Osteoporosis is a new domain in the GMS contract for 2012/13. Brown P, Carr W, Mitchell PJ. Guidelines in Practice, April 2012;15(4):47-55.
- The National Hip Fracture Database: The largest ongoing audit of hip fracture care and secondary prevention in the world with >250,000 cases documented.
- The Best Practice Tariff for Hip Fracture: A quality incentive for hospitals which includes osteoporosis and falls assessment for hip fracture patients on discharge from all hospitals in England.
Professional guidelines
The care of patients with fragility fracture. British Orthopaedic Association and British Geriatrics Society. 2007.
National Osteoporosis Society
The National Osteoporosis Society (NOS) has led a national campaign for universal access to Fracture Liaison Services since 2009. Resources include:
- FLS Implementation Toolkit. National Osteoporosis Society. 015.
- UK FLS Clinical Standards. National Osteoporosis Society. 2015.
- Fracture Prevention Practitioner Training. National Osteoporosis Society. 2015.
- Osteoporosis Resources for Primary Care website. National Osteoporosis Society. 2012.
In 2012, a multidisciplinary Falls and Fractures Alliance was established in England with the objective of reducing the rate of hospital admissions for (a) hip fractures and (b) falls and falls-related injuries in people over the age of 65 between 2012 and 2017.
UNITED STATES
National Bone Heath Alliance (NBHA)
Fracture Prevention CENTRAL: Promoting the Widespread U.S. Implementation of Post-Fracture Prevention and Care Coordination Programs
www.FracturePreventionCENTRAL.org
NBHA launched Fracture Prevention CENTRAL in March 2013, an online resource to help interested sites across the U.S. implement and maintain a post-fracture prevention program. Fracture Prevention CENTRAL includes materials collected from a number of successful programs, some of which have been in operation for over 15 years. With the guidance and resources provided, NBHA hopes to inspire others to implement a post-fracture prevention program to address the nearly 80% post-fracture care gap in the U.S. Fracture Prevention CENTRAL will begin a monthly webinar series in May 2013 to provide an opportunity for interested sites to learn more about this successful model of care.
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