Fracture liaison services are suboptimal in Ireland

Fracture liaison services (FLS) aim to reduce the risk of fragility fractures in patients. However, a new survey has revealed that such services are suboptimal in Ireland.

Fragility fractures are also known as low-trauma fractures because they usually occur following a minor fall (from standing height or less). They are a sign of osteoporosis and their incidence is rising as a result of an ageing population. In Ireland, this type of fracture is predicted to increase by 58% by 2030 - the highest of all EU countries.

People with a prior fragility fracture are at particularly high risk of further fractures, however in many cases, these are preventable. FLS aim to prevent secondary fragility fractures. 

The survey by the Royal College of Surgeons in Ireland (RCSI) involved the 16 public hospitals in Ireland that have an orthopaedic trauma unit in Ireland. It covered the year 2019 and involved patients who were 50 years or older.

The survey found that no trauma sites in the country were managing to capture all fracture patients.

Ten of the 16 sites (62.5%) reported the existence of FLS and managed 3,444 non-hip fractures during 2019, representing 19% of the expected non-hip fragility fracture numbers occurring annually in Ireland.

Six of the 10 sites surveyed reported that their services had been established more than a decade ago, but due to inadequate resourcing, they were failing to meet the 13 standards outlined in the international best practice framework.

Overall, FLS were found to be limited in many cases and poorly supported.

The findings highlight the need for a national policy to implement effective high-quality FLS in hospitals nationwide.

“We urgently need a policy to support the national implementation of FLS across Irish trauma hospitals. FLS provide the best method of identifying, treating and monitoring these patients and are proven to reduce fracture numbers, improve treatment for patients and substantially reduce the cost burden to the health service,” commented Dr Frances Dockery, joint clinical lead for the FLS Database, which is currently being developed.

According to Mr Paddy Kenny, joint national clinical lead for the National Clinical Programme for Trauma and Orthopaedic Surgery (NCPTOS), these findings “demonstrate the need for the implementation of FLS nationally as a matter of urgency”.

“FLS has been proven internationally to be effective clinically and economically for the management of secondary fracture prevention.  This service will result in reduced hospital admissions,” he noted.

Details of the survey are published in the journal, Osteoporosis International, and can be viewed here.