We are excited to inform you that Frimley Health NHS Foundation Trust has launched a new trust-wide Fracture Liaison Service (FLS) for patients who have sustained a fragility fracture. The FLS will help reduce the risk of further fractures, improve bone health and falls management, and support better long-term outcomes for patients - delivering significant benefits across acute, primary and social care. 

What to expect 
Patients aged 50 and over with a fracture of hip, wrist, humerus, pelvis or vertebrae within the last 3 months will be identified by the service using our patient management system called Epic. They will be assessed for osteoporosis and falls risk, and investigations such as blood tests and DEXA scanning will be arranged where appropriate. A treatment plan will then be recommended. Where primary care prescribing is recommended, this will be communicated to the GP in line with our outpatient prescribing guidelines: link. Follow-up will take place at 4 months and 12 months before discharge back to usual care with an ongoing management plan. 

The flow chart appears to show the follow-up timeline after a patient is identified by the Fracture Liaison Service. At 12 weeks, the patient is assessed by the FLS nurse. If needed, a falls assessment/referral is completed, and if appropriate, a DEXA scan and blood tests are arranged. A treatment decision is then reached, which may include anabolic treatment, zoledronic acid, oral bisphosphonate/denosumab, or no treatment. At 16 weeks, compliance with treatment is checked, and at 52 weeks, longer-term management and ongoing bone health care are reviewed.

Medication prescribing responsibilities 
We ask that once communication comes to primary care from the FLS, that recommendation for medications are reviewed and where accepted they are commenced on treatment as soon as possible (ideally within 2-3 weeks). Please let the service know if the medication cannot be initiated. The table below outlines the common treatments and their responsible prescribers. 

Drug Responsibility in line our outpatient prescribing guidelines: link
Oral bisphosphonate (alendronic acid, risedronate) Primary care 
Denosumab (TV Denosumab guidance in development)  Primary care (amber recommended drug / amber without shared care) 
IV bisphosphonate (Zoledronic acid)  Secondary care (FLS) 
Anabolic (Romosozumab/Abaloparatide/Teriparatide)  Secondary care (FLS) 

 

How to access the service in Primary Care 
If you have patients who meet the inclusion criteria detailed below and you are not sure whether the Trust has identified them through its EPR called Epic, please contact us via the A&G eRS service for ‘Rheumatology - Fracture Liaison Service - RD7’ (see eRS details below). We can then check and, if the patient has not been identified, convert the A&G request into a referral and support the patient through the FLS. Patients identified and managed through the FLS do not need a separate referral for DEXA or blood tests, as these will be arranged by the service. 

eRS Service Details – A&G service (Trust-wide / Cross-site) 
Speciality  Clinic Type   Service Name  Location    A&G service
Rheumatology  Bone/Osteoporosis   Rheumatology – Fracture Liaison – RD7  Wexham (cross-site service) Yes

 

Inclusion and exclusion criteria (as detailed in the eRS Directory of Service (DoS). 

 Appropriate (inclusion criteria): 

  • With history of the fractures below within 3 months: Pelvis – Humerus – Wrist – Hip - Vertebrae 

Inappropriate (exclusion criteria): 

  • Aged <50  
  • All other fractures not listed  
  • Fractures >=3 months old 
Procedures performed 
  • Blood tests 
  • DEXA Scan

 

For any questions please contact: 0300 615 2147 - this is the helpline number for patients and primary care (internal extension 155640). Email: fhft.fractureliaisonservice@nhs.net.

Educational Support: ‘Denosumab in Practice: Key Updates for Primary & Community Care’ - Thursday 17 September, 12:30 – 14:30: Please register for this event via this link