/ CHHS17/163

Canberra Hospital and Health Services

Clinical Guideline

Fracture Liaison Service (Osteoporosis Screening) for Adults

Contents

Contents

Purpose

Scope

Section 1 – Background

Section 2 – Identification

Section 3 – Assessment

Section 4 – Education

Section 5 – Intake Process

Section 5 – Follow Up

Implementation

Related Policies, Procedures, Guidelines and Legislation

References

Definition of Terms

Search Terms

Attachments

Purpose

This guidelineoutlines a consistent approach for Fracture Liaison Servicestaff to utilise to ensure clinical safety and improve outcomes for patients with osteoporosis.This guideline specifically assists clinicians with the identification of patients who have sustained minimal trauma fractures (MTF) and providing screeningfor eligiblepatients.

Back to Table of Contents

Scope

This guideline applies to:

  • Medical Officers
  • Nurses
  • Allied Health

Back to Table of Contents

Section 1 –Background

The Fracture Liaison Service is guided by a steering committee and includes representatives from:

  • Department of Orthopaedics, Division of Surgery and Oral Health, Canberra Hospital and Health Services (CHHS)
  • Department of Diabetes and Endocrinology, Department of Medicine (DOM), CHHS
  • Physiotherapy Department, University of Canberra
  • Trauma and Orthopaedic Research, CHHS
  • General Practice Department, ACT Health
  • Department of Rheumatology, DOM, CHHS
  • Department of Geriatric Medicine, Rehabilitation Aged and Community Care (RACC), CHHS
  • Falls Assessment and Prevention Service, RACC, CHHS
  • Ambulatory Care and Community Support Services, Cancer and Ambulatory Care Health Services (CACHS), CHHS
  • Central Outpatients, CACHS, CHHS
  • Fracture Liaison Coordinator, CACHS, CHHS

Key Objective of this guideline

Assist clinicians to:

  • Identify patients likely to have osteoporosis
  • To investigate ‘at risk’ patients appropriately and systematically
  • To compile results of investigations for clear communication to assistthe General Practitioner (GP) to commence treatment
  • To identify a subgroup of patients who require input from falls, geriatrics, rheumatology and/or endocrine services and refer appropriately.

Key Objective of the Fracture Liaison Service

  • To provide a systematic evidence-based approach for the identification, investigation and targeted referral of patients with MTF
  • To provide a central agency with expertise in MTF as a resource and link between the acute and community sectors
  • To provide better awareness of the risk of MTF in the ACT community
  • To maintain surveillance of MTF patients and assess the outcome of intervention in terms of patient reported outcomes, compliance with treatment, and prevention of a further fracture.

Key Performance Indicators

The performance indicators for this Service are based on the Internal Osteoporosis Framework and the 13 criteria that it describes as part of its best practice framework.

For further details about each of these criteria, please refer to

Back to Table of Contents

Section 2 – Identification of patients likely to have osteoporosis

Patients are to be identified as per the flow chart in Attachment 1

  • Clinic lists for existing fracture clinics at Canberra Hospital and Health Services for each week will be screened prior to clinic by the Fracture Liaison Coordinator
  • Initial assessment of all people who meet the age criteria with a secondary assessment undertaken via patient notes and the final assessment in the form of a questionnaire will establish those patients who meet the MTF testing eligibility criteria

Back to Table of Contents

Section 3 – Assessment

  • Assessment attended based on questionnaire and CRIS notes
  • Education session then provided to the patient, including information relating to their risks of osteoporosis
  • Patients will be offered pathology and bone mineral density imaging
  • Patients will be given an information sheet about what the service offers and outlines expectations of both Canberra Hospital and Health Services and the patients involved (Handout available on Policy Register – Fracture Liaison Service Information).
  • The Ontario modified STRATIFY screening tool will be used to further assess patents for falls risk
  • FRAX and Garvan online calculators will be attended for each patient who attends full testing
  • FRAX -
  • Garvan -
  • Data entered into database stored on Q drive
  • Q:\CRCS\Ambulatory Care Support Services\Outpatient Service Clinical Support\Clinic Information_Minimal Trauma Fracture\8. Data, Analysis, Results
  • Results entered as they become available by a member of the Fracture Liaison Service or delegated as required.
  • Further assessment of patient results will be done by the Fracture Liaison Coordinator and Specialists which will assist to guide further testing and referrals.

Back to Table of Contents

Section 4 – Education

  • Generic vitamin D, Calcium and Exercise education will be provided for all patients entering the Fracture Liaison Service.
  • The education provided to patients will be from Osteoporosis Australia handouts and available local community
  • All patients will be given an information sheet outlining the education that they received from the Fracture Liaison Service(Handout available on Policy Register – Fracture Liaison Service Education).

Back to Table of Contents

Section 5– Intake Process

  • Intake into the Fracture Liaison Service will be through screening of fracture clinic patients.
  • Patients who enter the service and are found eligible shall be referred to the Endocrinology department, as per the flow chart (Attachment 1).
  • Patients who score ≥ 9 on the Ontario Modify STRATIFY will be discussed between the Fracture Liaison Service and the geriatrics and falls service representatives from the steering committee and referred to an appropriate service.
  • All patient data with be communicated back to the nominated GP for treatment initiation, continuation and monitoring, as per the flow chart (Attachment 1).
  • Patients who indicate that they have no current GP or wish to change GPs will be referred to the General Practitioner Liaison Unit (GPLU). Patients will be given GPLU contact details. GPLU will be emailed when patients identify a need for GP services.

Back to Table of Contents

Section 5 – Follow Up

  • Patients will be followed up by the Fracture Liaison Service at one, two, five and ten years by mail/email
  • Follow up will involve providing patients with a questionnaire (available from Clinical Record Forms Register) either by post, electronically, in person or by phone.
  • Patients requesting further information sessions, additional investigations or explanation of results will be referred back to their GP.

Back to Table of Contents

Implementation

Staff will be advised of the guideline through orientation and staff meetings.

Back to Table of Contents

Related Policies, Procedures, Guidelines and Legislation

National Healthcare Standards

  • National Standard 1: Governance for safety and quality in health service organisations
  • National Standard 2: Partnering with consumers
  • National Standard 10: Preventing falls and harm from falls

Back to Table of Contents

References

  1. AIHW 2014. Estimating the prevalence of osteoporosis in Australia. Cat. no. PHE 178.

Canberra: AIHW.

  1. ACI Musculoskeletal Network, NSW Model of Care for Osteoporotic Refracture Program, 2011
  2. Nairn, L. Brake the Break Osteoporosis Refracture Prevention Service: Evaluation report (July 2015)

Back to Table of Contents

Definition of Terms

  • MTF – Minimal Trauma Fracture - defined as a fracture resulting from a force equivalent to or less than that associated with a fall from standing height.
  • GP – General Practitioner
  • GPLU – General Practitioner Liaison Unit
  • FLS – Fracture Liaison Service

Back to Table of Contents

Search Terms

Fracture, Minimal Trauma Fracture, Osteoporosis

Back to Table of Contents

Attachments

Attachment 1 – Flow Chart for FLS

Disclaimer: This document has been developed by Health Directorate, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

(to be completed by the HCID Policy Team)

Date Amended / Section Amended / Approved By
Eg: 17 August 2014 / Section 1 / ED/CHHSPC Chair

Attachment 1 – Flow Chart for FLS

See next page for tables and exclusion criteria

Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS17/163 / 1 / 25/07/2017 / 01/05/2019 / CACHS – Ambulatory Care / 1 of 9
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register