Prevent Osteoporotic Fractures with a Fracture Liaison Service

System Challenges

Diagnosing osteoporosis and getting patients to believe in and commit to a treatment plan pose many challenges. Many patients do not believe they have suffered a fracture due to osteoporosis and place the blame entirely on the low level of trauma that preceded the fracture. In the care of medically complex patients, precious clinic time is often diverted toward seemingly more pressing health conditions, such as diabetes, hypertension and cardiovascular disease. The beauty of an FLS is the diagnosis is already made; patients who suffer an osteoporotic fracture need osteoporosis treatment.

James Larsen, MD, a geriatrician at LLUH, laments over the issue of non-
adherence. He notes that at our institution, “there is no problem getting patients screened for osteoporosis; the problem is getting patients committed to treatment. Patients are worried about the side effects of treatment.”

His concerns echo studies showing that since 2002 a decline in prescribing rates for bisphosphonates has corresponded with a profound increase in fragility fractures among women.⁹ The risks of atypical femur fractures and osteonecrosis of the jaw with the use of bisphosphonates have been overly emphasized by the media, drowning out the loss of independence, infection and mortality that can follow immobility from fractures.

There is hope. The National Osteoporosis Foundation (NOF) has played an instrumental part in fighting osteoporosis nationally by providing education to health professionals and the general public. In addition to raising awareness of the scope of the problem, the NOF takes a stand to help eliminate it by providing health professionals training and certification in Fracture Liaison Services. The NOF also offers guidance on diagnostic assessment, monitoring and pharmacologic treatment in its Clinician’s Guide for Treatment of Osteoporosis, published and updated since 1999.⁴

At Loma Linda University Health System, the FLS improves the rates of screening and diagnosis prior to a fracture, decreases the incidence of refracture and increases awareness of the consequences of osteo­porosis among patients and primary care physicians. The goal is to bring the national average for appropriate post-fracture osteoporosis management to the level of breast cancer screening and beta blocker treatment after a myocardial infarction.

Imagine that.

Micah Yu, MD, is a rheumatology fellow at Loma Linda University, Calif.

Anna Lafian, DO, is a rheumatology fellow at Loma Linda University, Calif.

Christina Downey, MD, RhMSUS, CCD, is an assistant professor of medicine in the Division of Rheumatology at Loma Linda University, Calif.