In August 2015, the International Osteoporosis Federation (IOF) judged that the Newcastle Hospitals Trust Fracture Liaison Service (FLS), had moved from BRONZE to a GOLD standard. We are the only FLS service currently recognised by the IOF in the North East of England and one of only four centres in the British Isles to have been credited with a GOLD standard.
The Newcastle FLS was first developed in 1999, since which time more than 12,000 outpatients have been assessed. FLS also occurs for inpatients within the ortho-rehabilitation services. The FLS is nurse-led for all assessments (including DXA) which are performed in the Fracture Clinic, where a “one-stop-shop” is offered by the specialist nurse, while patients are waiting to see their orthopaedic surgeon. All patients aged over 50 years with a low trauma fracture have a fracture risk assessment, including a lifestyle questionnaire and bone mineral density measurement. A standard letter is sent out to family doctors, which includes the results of the assessment and treatment recommendations. There is also a weekly dedicated Bone Clinic in the fracture clinic to follow up more complex cases, while the inpatient assessments performed by our orthopaedic rehabilitation team are supported by FLS staff.
We believe our success is related to ambitious targeting of all patients aged over 50 years who sustain a fracture, co-ordination between orthopaedic, geriatric medical and metabolic bone services and the support of health service commissioners and hospital managers in making this a robust service. However, we are not complacent, and must now focus on maintaining and improving services, including targeting vertebral fracture case finding and supporting family doctors in fracture risk assessment to ensure that secondary prevention is implemented.