FRACTURE LIAISON SERVICE. OUR EXPERIENCE IN POLAND

Abstract

Fractures are the essential problem of osteoporosis, therefore identification of patient at risk is crucial. This is widely known that patients with higher risk, increased in these group 2 to 6 times. Orthopedic surgeon is the first and usually the last doctor who sees the patients, but unfortunately, only 10 to 20% of these patients are treated. This situation led to founding Fracture Liaison Service (FLS) system in Europe and the USA. This system is based on a coordinator (CO) employed on a trauma ward, who is responsible for secondary fracture prevention. A CO identifies patients who sustained a low trauma fracture and educates them about the risk of a next fracture and prevention methods. He also initiates osteoporosis diagnosis and treatment. Thanks to the support of Amgen Poland the Polish Osteoarthrology Society launched 16 centers in various part of Poland in 2015. Prior to the initiation of FLS a report on osteoporosis in Poland and program assumptions were prepared together with educational materials for doctors and patients. Digitalized reports were sent by COs to the central office and were inserted to the National Database. In this way a registry of osteoporotic fractures and data on fracture prevention were created. After 18 months of activity 1,553 patients were included, 746 DXA scans were done, 492 doctor consultations took place, 374 patients started therapy and 535 calcium and vitamin D supplementations were implemented. Unfortunately, due to funds exhaustion the system was officially closed on 01.06.2015, nevertheless an appropriate extensive program proposal was sent to the Polish Ministry of Health. Without a doubt, an education outreach campaign for orthopedic surgeons, health service managers and patients was our great success. The main impediment of this program and similar ones was the underfunding of health service and apprehension of possible liabilities due to FLS activities. Additional problems were work overload of ward personnel and the lack of fall prevention system in Poland. Cost-effectiveness of FLS is well documented worldwide however everyday costs have to be covered by a given hospital with no refunding from National Health Founds.