Queen Elizabeth Hospital

Early Fracture Liaison Service experience in Hong Kong

The rapidly aging population of Hong Kong (HK) with increasing life expectancy poses high prevalence of osteoporosis. According to the Hospital Authority’s (HA) statistics, the incidence of Fragility Fracture (FF) in 2017 in HK was 16, 301 cases, which was higher than the incidence of other serious illnesses like acute myocardial infarction (14,050) and acute cerebrovascular accident (12,201). Around 70% of FF patients had deteriorated mobility at 1-year follow-up when compared to their pre-morbid status (Leung et al., 2017). The prescription rate of osteoporotic drugs in HK was 9.24%-15.03%, which was suboptimal and lagged behind some Asian countries e.g. Taiwan, Singapore, Korea (Ho & Wong, 2015). The impairment of mobility and self-care ability, inadequate osteoporosis care and lack of fall prevention program cause FF patients fall into secondary fracture cycle which was 4% in post-discharge 1 year (Leung et al., 2017). The solution to break this cycle is to develop an effective Fracture Liaison Service (FLS).

Many developed countries have already built up their own cost-effective and well-structured FLS to combat secondary fractures. Yet in HK, FLS is still in its sprouting phase. In 2017, HA has approved 3 acute public hospitals in different clusters as pioneers to develop FLS and three advanced practice nurses were appointed to be Fracture Liaison Nurses (FLN). They form a network to share and update the progress of own FLS development as well as to identify common responsibilities and outcome measures.

FLS team in Queen Elizabeth Hospital (QEH) developed FLS with reference to International Osteoporosis Foundation’s Best Practice Framework (BPF). FLS team emphasizes multidisciplinary collaboration and is coordinated by FLN. Currently, the team identifies Fragility Hip Fracture (FHF) patients from in- and out- patient orthopedic department. FLN ensures that FHF patients have smooth patient journey under the integrated care pathway, performs bone health assessment and education to patients/carers and initiates osteoporotic treatment in early post-operative period. In outpatient FF clinic, the team carries out multifaceted health and lifestyle risk factors assessment, osteoporosis medications’ review and treatment and fall prevention services for the follow-up patients. FLN also conducts phone follow-up to monitor their medication compliance.

QEH FLS team tries to achieve 13 BPF but the team faces many challenges when implementing FLS. For example, high case load in our center, osteoporosis service confined to fragility hip fracture because of limited manpower, long waiting time for DXA scan. In addition, referral mechanism for treating secondary causes of osteoporosis still has room for improvement. As FLS is one of the pioneer services in HA, the team lacks local experience to learn from and still needs to explore its future development. We are uncertain about the sustained support and resources that will be provided by HA but our team continues to make unremitting efforts to face the challenges.

Reference

Ho, A. W. H. & Wong, S.H. (2015). A population-based analysis of the post-fracture care gap in Hong Kong: the situation is not improving. OSTEOPOROSIS INT, 26 (1), 396-397.

Leung, K. S., Yuen, W. F., Ngai, W. K., Lam, C. Y., Lau, T. W., Lee, K. B., Siu, K. M. Tang, N., Wong, S. H. & Cheung, W. H. (2017). How well are we managing fragility hip fracture? A narrative report on the review with the attempt to set up a Fragility Fracture Registry in Hong Kong. In Hong Kong Med J,23(3). Retrieved March 19, 2018 from http://www.hkmj.org/abstracts/v23n3/264.htm