Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or 'low energy') trauma. Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
In the UK over 3 million people are known to have osteoporosis and there are
estimated to be over 500,000 fragility fractures that occur in the UK each year, representing a cost to the NHS of £4.4 billion a year, adding up to 1.3 million bed days and a cost of £1.5 billion each year.
Furthermore, hip fractures alone account for 69,000 emergency admissions into hospitals, with approximately 1.8 million hospital bed days and £1.9 billion spent in hospital costs every year, excluding the added cost of social care.
In this instance prevention is better than cure, to effectively manage the number of cases, preventing falls requires action to be taken over a multi staged approach, such as targeted case finding, universal assessment of risk factors and implementation of appropriate interventions. Through early detection and intervention many of these fractures can be prevented. The NHS Rightcare Falls and Fragility Fractures pathway identified three priority areas for optimisation:
Detecting and Managing Osteoporosis
Optimal support after a fragility fracture
Currently 35% of local health services in England provide a Fracture Liaison Service (FLS) pathway, organisations such as the Royal Osteoporosis Society have worked to raise awareness about the importance of delivering a robust FLS service and how to improve bone health.
In a survey conducted by the ROS of more than 3,000 people living with osteoporosis, 42% felt socially isolated by their osteoporosis, one in three reported difficulty with domestic chores and more than 40% of those who had fractures said they were in long-term pain which they did not think would ever go away.
A standardised approach is required to ensure that a consistent level of service is delivered nationally. Unfortunately, 41% of the UK population currently does not have access to an FLS and the overall service provision varies across the country. Scotland has 100% coverage, whilst Northern Ireland is close to achieving the same, but in England the coverage is a mere 53%.
According to analysis by ROS experts in the field, they compared standards in different areas of the country to draw out inequalities in access. Yorkshire, Merseyside and London are regions with insufficient access to FLSs: six hospitals in Yorkshire; six in Merseyside and five in London do not have a FLS. If everyone living in just these three regions alone had access to a FLS, it would save the NHS £6.8m per year and prevent over 4,000 broken bones over a five-year period. Even living on the wrong side of a city can markedly increase a person’s risk of re-fracturing, due to lack of access to a FLS. The quality of these services also varies across different regions.
There are some simple measures that we can all take to protect the health of our bones, these include actions such as staying active and eating healthy and ensuring that we get enough calcium and vitamin D into our diets, which will naturally enhance bone health. Everyone needs vitamin D, which is essential for good bone health. Low levels are linked to bone disorders including rickets in children, and osteomalacia and osteoporosis in adults.
NHS Food for healthy bones guidelines recommend adults need 700mg of calcium a day, foods such as milk, eggs and fish contain high volumes of calcium. There is currently no accepted ‘optimal’ level of vitamin D, however the NHS suggest adults require approximately 10 micrograms of Vitamin D, it is not possible to get this daily dose of vitamin D from sunlight alone. The additional vitamin D can be gained from fortified foods such as fat spreads, and natural dietary sources particularly oily fish (including salmon, trout and sardines) can be useful for helping to maintain levels of vitamin D. These sources are particularly important during the winter and among people at higher risk of low vitamin D.
In conclusion, there is substantial evidence to demonstrate the clinical benefit and cost-effectiveness of setting up an FLS, evidence indicates that preventing falls and fragility fractures can generate substantial cost savings for health and social care providers. How these services are delivered, accessed, managed and rolled out is critical to ensuring the success of the programme. Organisations such as the ROS have developed frameworks and toolkits to aid the commissioning of a fracture liaison service and the team at Open Medical can provide solutions, support and guidance on digitising a fracture liaison service.
Moreover, it is important to highlight the benefits of setting up a digital FLS in comparison to the traditional paper based version. Not only does it improve efficiency, save time for the nurse especially on admin tasks, it also ensures clinical safety as no patients get missed accidentally or forgotten when it comes to follow ups, as Pathpoint FLS has automatic triggered alerts and reminders. Get in touch today to discuss setting up digital FLS in your NHS Trust.