Hospital Lapeyronie

MONTPELLIER FRACTURE LIAISON SERVICE

The Lapeyronie Hospital is a public University Hospital located in Montpellier, France. The fracture liaison service (FLS) was initiated in 2014 as a cooperative effort between orthopaedic surgeons, rheumatologists and geriatric physicians. It also involves nutritionists, nurses and physiotherapists. The coordinator of the FLS is Dr Helene Che, rheumatologist (h-che@chu-montpellier.fr).

Step 1: Identification of patients

Patients suffering from low-energy fractures are identified in one of three ways:
• by our residents in the orthopaedic department of Lapeyronie Hospital (wrist fractures, hip fractures);
• by staff practitioners while hospitalized in the department of rheumatology (mostly vertebral fractures);
• referred to the FLS by other specialists, such as from radiology, neurosurgery, emergency etc. (fractures of any type)

Step 2: Patient contact

Each patient is individually contacted either physically when hospitalized in the rheumatology or orthopaedic departments or by phone (several attempts).

Every patient receives information on the importance of screening for osteoporosis in order to optimize individual treatment. In case of refusal or failure to contact, the cause is collected and recorded.

Step 3: Takeover proposal

Patients are requested to come either for a one-day hospitalization or for an outpatient visit (prioritized option). During the one-day hospitalization, they are evaluated by a physiotherapist, nurses, nutritionist, rheumatologist, and the usual biological tests and DXA testing are performed. If the patient is considered to be at falls risk, they are also evaluated by a geriatric practitioner in order to assess the falls risk, and to correct or prevent them. If it is an outpatient visit, the patient undergoes biological testing and DXA testing prior to the visit.

At the end of the hospitalization or the visit, the rheumatologist indicates whether anti-osteoporotic treatment is required, according to recommendations of the national scholarly society GRIO (Group on Research and Information on Osteoporosis) and French recommendations.
The treatment order is delivered directly to the patient. A letter is sent to the patient’s general practitioner. An appointment is given to the patients 3-6 months later, in order to ensure adherence to treatment and to follow-up clinical evolution.

Step 4: Saving the data

For each patient, a computerized record is completed on administrative, clinical, and paraclinical data.