School of Medicine, University of Notre Dame Australia, Sydney, Australia; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Osteoporosis New Zealand, Wellington, New Zealand.
Maturitas. 2022 Nov;165:26-32. doi: 10.1016/j.maturitas.2022.07.001. Epub 2022 Jul 13.
Over the course of the first half of the 21st century the age structure of the human population will have undergone dramatic change, leading to what has been described by the Fragility Fracture Network and the International Osteoporosis Foundation as a new demographic era. In the absence of widespread implementation of systematic approaches to chronic disease management, and prevention and treatment of osteoporosis and fragility fractures in particular, fracture rates among older people will increase significantly by mid-century. The purpose of this narrative review is to characterise the current and projected burden of fragility fractures, evaluate current gaps in delivery of best clinical practice, and summarise the literature on the Fracture Liaison Service (FLS) model of care. A definition of FLS is provided, in addition to findings of systematic reviews and associated meta-analyses conducted to assess the clinical and economic benefits of FLS. Initiatives intended to enable benchmarking of the quality of care provided by FLS are reviewed, including the flagship International Osteoporosis Foundation Capture the Fracture® Programme and examples of national clinical standards for FLS from several countries. The emergence of national clinical registries to facilitate benchmarking against clinical standards is also considered. Finally, a precis is provided of several global and regional initiatives that aim to support changes in healthcare policy to provide funding, at scale, to support widespread implementation of FLS.
在 21 世纪上半叶，人口年龄结构将发生巨大变化，这被脆性骨折网络和国际骨质疏松基金会描述为一个新的人口统计学时代。如果没有广泛实施针对慢性病管理的系统方法，特别是预防和治疗骨质疏松症和脆性骨折，到本世纪中叶，老年人的骨折率将显著增加。本叙述性综述的目的是描述脆性骨折的当前和预计负担，评估目前最佳临床实践提供方面的差距，并总结骨折联络服务（FLS）护理模式的文献。除了提供 FLS 的定义外，还提供了系统评价和相关荟萃分析的结果，以评估 FLS 的临床和经济效益。审查了旨在实现 FLS 提供的护理质量基准的举措，包括国际骨质疏松基金会的旗舰项目“Capture the Fracture®”计划以及来自多个国家的 FLS 国家临床标准的示例。还考虑了国家临床登记处的出现，以促进与临床标准的基准比较。最后，简要介绍了几个旨在支持医疗保健政策变化的全球和区域举措，以便为广泛实施 FLS 提供资金支持。
