This is the eighth annual report for the Fracture Liaison Service Database (FLS-DB). You’ve had a fracture how can we prevent another? provides national benchmark performance for the care of people with fragility fractures in 2023.
You’ve had a fracture; how can we prevent another?
The Fracture Liaison Service Database (FLS-DB) collects, measures and reports on the care provided by FLSs. Since it began in January 2016, nearly 500,000 patient records have been entered by FLSs across the NHS, in England, Wales and Northern Ireland.
This year’s annual report saw an improvement in most KPIs, with the exception of KPI 1 for data completeness. However, many outcomes remain low, particularly getting high risk patients onto anti osteoporosis treatment. The aim is for FLSs to ensure that within 16 weeks of a fracture diagnosis, over half of patients with a high fracture risk have started on NICE recommended anti osteoporosis treatment.
Local commissioners and FLSs should use this report to improve the effectiveness in post-fracture care delivery from existing FLSs through service improvement and additional commissioning to reduce the number of preventable fragility fractures in this high-risk patient group.
If your organisation (hospital, primary care practice, network and/or other community service) treats fractures you need to participate in the FLS-DB.
'This is the first year the FLS-DB is comparing the number of patients on anti-osteoporosis treatment at 16 and 52 weeks. This year’s report focuses on maximising the number of fractures an FLS prevents by ensuring those patients at high fracture risk receive treatments as recommended by NICE. The refocus for FLS from increasing patient volume reflects the capacity issues many FLSs have in seeing more patients. By ensuring FLS prioritise identifying the higher risk patients and these patients are appropriately treated improves the effectiveness and efficiency of an FLS. The report includes practical steps FLSs can use to review their current performance to improve their KPI’s'
Kassim Javid, FLS-DB clinical lead
- All integrated care boards (ICBs) and Welsh health boards should provide a strategic plan for effective secondary fracture prevention for their locality. This should be based on relevant NICE recommendations and FLS-DB key performance indicators specifically focusing on KPI 10, which measures the treatment initiation in patients at high fracture risk.
- 100% of all ICBs and Welsh health boards should report the regional impact of fragility fractures in adults aged 50 or over and publish a high-level strategic plan to improve secondary fracture prevention for their population, focusing on delivering KPI 10.
- ICBs and Welsh health boards should facilitate local FLS clinical leads to complete at least one service improvement cycle to improve KPI 10, initiation of appropriate treatment by 16 weeks after fracture diagnosis or adherence at 52 weeks after fracture diagnosis.
- ICBs and Welsh health boards should support regional advocacy groups for the establishment and improvement of FLSs. These advocacy groups would increase the quality of patient/caregiver engagement for local FLSs service improvement teams and establish the implementation of FLSs in areas without coverage. This is with the aim of increasing identification of patients who require fragility fracture care and ensuring that they receive the appropriate follow-up care.
- ICBs and Welsh health boards should work with FLSs and primary/community care in the co-production of sustainable patient pathways for primary care delivery of anti-osteoporosis treatment, such as injectable treatments. This is with the aim of facilitating better communication and transition of patient management between primary/community care and FLSs. This is in line with the findings from KPI 10 and KPI 11 outlined in appendix A, which demonstrate the lack of availability and prescription of anti-osteoporosis treatment among FLSs.