Based in Holland, the Dutch Maxima Medical Centre started its Fracture Liaison Service programme in 2004 with a mission to ‘Stop At One: Making your first fracture your last’. This programme is a collaboration among an endocrinologist, a nurse that specializes in fracture care, a nurse practitioner, orthopedic surgeons and each patient’s general practitioner.
Patients are initially identified in the emergency department, following the incident of a fracture. All fracture patients over 50 years of age are invited for a DXA scan with a Vertebral Fracture Assessment (VFA). After the DXA/VFA scan, they immediately visit a nurse that specializes in fracture care as well as an endocrinologist. The fracture nurse executes a fracture risk assessment, delivers patient education and orders the necessary lab tests or X-rays associated with the injury. A treatment plan is discussed by the endocrinologist, together, with the patient. This treatment plan contains a combination of lifestyle changes and appropriate medical treatment. After this one-stop-shop visit, the patient’s GP is informed and from that point on will become the point person related to treatment and follow up. The patient is also kept under the nurse practitioner’s or endocrinologist’s observation in case of secondary risk factors. Secondary risk factors include diseases that directly or indirectly affect bone remodeling and conditions that affect mobility and balance, which can contribute to an increased risk of falling and sustaining another fracture.
For more information, visit the Dutch Maxima Medical Centre http://www.mmc.nl/