Liaison Program Works To Prevent Fragility Fractures in Older Adults
For older adults, one break all
too frequently leads to another.
Studies have shown that anyone age
50 or older who suffers a fragility fracture – a bone break sustained in a fall
from a standing height or less – is two to five times more likely to experience
a second fracture than someone who hasn’t had one. The odds that a person who’s
suffered two such fractures will have a third are even higher.
The underlying cause for the vast
majority of these non-traumatic fractures is osteoporosis, a progressive
disease that decreases the weight and density of bones, making them more
brittle. Osteoporosis doesn’t have any obvious symptoms so in most cases it
isn’t noticed until a fracture occurs – and those fractures are anything but
According to the National
Osteoporosis Foundation (NOF), about half of all women and one-quarter of all
men will suffer at least one fragility fracture after age 50. There are more
than 2 million fragility fractures in the United States each year – more than
the number of heart attack, stroke and breast cancer cases combined – with an
estimated direct cost of nearly $20 billion. These breaks can significantly damage
an individual’s quality of life and contribute to other serious health problems,
Despite all that, about 80
percent of all older Americans who sustain fractures are neither tested nor
treated for osteoporosis. But things are changing.
“Orthopaedics has traditionally
focused on fixing the fracture, but we’ve realized that is only part of our
responsibility as physicians,” says Cynthia Emory, MD, an orthopaedic surgeon
with Wake Forest Baptist Health. “Identifying and treating the underlying cause
is equally important so we can prevent fractures from occurring and enable our
patients to continue doing the activities they enjoy.”
Experts agree that fracture
liaison services represent an effective way to do both the identifying and the treating.
A fracture liaison service (FLS)
is a multispecialty, preventive-care program designed to foster bone health in
older adults, thereby reducing the risk of fragility fractures. Well-established
and with proven records of success abroad, notably in the United Kingdom and
Canada, FLS programs are catching on in the United States, thanks in part to initiatives
by the NOF, National Bone Health Alliance (NBHA), American Orthopaedic
Association and other organizations.
Last fall, Wake
Forest Baptist became one of the first academic medical centers in the country
to establish a formal FLS program, an effort led by Emory, fellow orthopaedic
surgeon Anna Miller, MD, and certified nurse practitioner Anne Lake, who serves
as the program’s coordinator.
Wake Forest Baptist’s
FLS enrolls people 50 and older who have suffered a fracture or who have a
medical condition that can adversely affect bone density. The initial visit for
each patient includes a thorough review of his or her medical history and a
physical examination. Depending on what those reveal, lab tests, X-rays and a
bone-density scan may be administered.
After all the results
are collected and analyzed, the patient receives an individualized plan that
may include an exercise program, dietary and lifestyle recommendations, non-prescription
supplements and prescription medications, all geared toward increasing bone
health and decreasing the risk of future breaks.
scheduled for follow-up visits as needed, during which their progress is
evaluated and their care plan is adjusted, if necessary.
The service provides
“full-perspective care coordination,” says Lake, whose job as FLS coordinator
includes gathering all the information about the patients, developing their
therapy plans, guiding the patients through the program, and keeping all of
their doctors and other caregivers in the loop about their status.
primary-care physicians obviously play major roles,” says Lake, who holds a
doctor of nursing practice degree. “But we’ll also consult endocrinologists,
rheumatologists, dietitians, physical therapists – basically anyone who can
contribute to determining what’s best for the individual patient.”
In addition to
managing Wake Forest Baptist’s service, Lake is involved in efforts by the NOF
and NBHA to provide hospitals and other providers with models that will help
them establish FLS programs regardless of their size or scope, and to develop
standards for FLS programs with an eye toward their being recognized by The
Joint Commission, the independent organization that accredits and certifies
health care organizations and programs in the United States.
services incorporate three important aspects of health care that are being emphasized
today – prevention, coordinated care and personalized medicine,” Miller says. “They
have been proven to be very successful in reducing the number of fragility
fractures, so there’s every good reason to make them available for everyone.”
detailed information about the Fracture Liaison Service, call 336-716-8565.