Meeting international standards of secondary fracture prevention: a survey on Fracture Liaison Services in the Netherlands

A Summary The Fracture Liaison Service (FLS) is advocated to be effective for the prevention of secondary fractures, but implementation is variable. A questionnaire based on the International Osteoporosis Foundation (IOF) Capture the FractureA (R) FLS standards was used in the current study. The results showed high compliancy with the IOF standards in the Dutch responding hospitals.

Introduction The FLS is advocated for the prevention of secondary fractures, but its implementation varies between hospitals and countries. The present survey applied the standards proposed by the IOF to evaluate the implementation of FLSs in non-university hospitals in the Netherlands.

Methods A questionnaire based on the IOF FLS standards was used in this study, requesting the selection, evaluation and treatment data of patients older than 50 years with a recent fracture.

Results Of 90 invited hospitals, 24 (27 %) fully responded, providing data of 24,468 consecutive patients, corresponding with 25 % of fracture patients in the Netherlands in the year 2012. After excluding skull and toe fractures and patients exceeding the upper age limits applied by individual hospitals, 11,983 patient data were available for analysis. The data showed high compliance (> 90 %) for fracture patient identification, invitation for FLS, timing of assessment, identification of vertebral fractures, application of national guidelines, evaluation of secondary osteoporosis, drug initiation when indicated, communication with the general practitioner and application of follow-up strategy and 70 % for fall prevention. The response rate was on average (49 %).

Conclusions The available data also showed that patients attending the FLSs were evaluated, treated and followed in high compliancy with the IOF standards. Some standards are open to different interpretations and may need further specification. The major shortcoming in FLS practice was that patients invited to attend the FLSs showed a low response rate. None of the hospitals achieved the IOF standard patient response rate of over 90 %.