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Fragility fractures

AHSN CIA / Project / Fragility fractures

Fragility fractures

Osteoporosis is the most common chronic bone disease affecting both women and men, and affects approximately 3 million people in the UK. The disease is characterised by low bone density which is a major risk factor for fragility fractures. Fragility fractures occur in 1 in 2 women and 1 in 5 men over 50 years of age. The fractures most commonly occur in the spine, hip and wrist, but can also occur in the arm, pelvis, ribs and other bones.

Osteoporotic fragility fractures can cause substantial pain and severe disability, often leading to a reduced quality of life, and hip and vertebral fractures are associated with decreased life expectancy. Hip fractures:

  • nearly always require hospitalisation
  • permanently disable 50% of those affected, preventing independent living
  • are fatal in 20% of cases

People who have had one fracture remain a greater risk of sustaining another, secondary fracture. Prevention of a secondary fracture will therefore improve quality of life and reduce health and social care costs. National guidance provides evidence that effective case finding and effective treatments will reduce the risk of future fragility fracture.

This project, working in partnership with the National Osteoporosis Society and with the assistance of the FRiSCy Network (Fracture Reduction in South Central policy), to implement Fracture Liaison Services across the Oxford AHSN region. There is strong evidence to demonstrate that investment in Fracture Liaison Services results in improved quality of care for patients as well as financial savings for commissioners of health and social care.

Potential 5 year savings

The table below outlines the potential 5-year savings, across health and social care, if full fracture liaison services were in place.

CCG & Social Care Total Fractures Saved Total Financial Savings (£)
Aylesbury Vale 122 961,278
Chiltern 206 1,644,542
Bedfordshire 262 2,084,155
Berkshire East 216 1,740,930
Berkshire West 267 267
Milton Keynes 122 965,120
Oxfordshire 403 403
TOTAL 1598 12,715,171

Fracture Liaison Service

A Fracture Liaison Service is responsible for the secondary prevention of osteoporotic fractures through the systematic assessment of patients who have suffered a fragility fracture. The service will:

  • proactively identify all patients over the age of 50 who have suffered a fragility fracture
  • assess bone health and falls risk, including osteoporosis assessment
  • inform patients of future fracture risk and discuss ways to reduce this risk
  • intervene to improve bone health, such as medication recommendations and referral to other specialist services such as falls prevention
  • integrate across primary and secondary care to ensure long-term management and treatment
  • evidence quality of service provision through data capture and audit

The benefits of the service include:

  • reduction in the number and cost of unplanned admissions due to secondary of subsequent fractures, with a positive impact on improving the patient flow and capacity through the acute hospital and social care
  • consistent and comprehensive service provision for all fracture patients over the age of 50
  • coordination of patient care between primary and secondary care settings
  • enhanced communication between health care providers by providing a care pathway for the treatment of fragility fracture patients
  • significant reduction in morbidity and mortality for older people
  • increase in medication compliance
  • appropriate signposting to other services
  • provision of a cost-effective way of delivering best practice and achieving outcome indicators

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