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Fracture liaison services in Ireland—how do we compare to international standards?

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Abstract

Summary

In this first na tional survey of public hospitals in The Republic of Ireland, we found fracture liaison services (FLS) to be heterogeneous, limited in many cases and poorly supported. A national strategy is urgently needed to support the implementation and operation of an FLS, and thus help reduce the burden of fragility fractures for patients and the healthcare system.

Introduction

Fragility/low-trauma fractures are a global concern, whose incidence is rising as the population ages. Many are preventable, and people with a prior fragility fracture are at particularly high risk of further fractures. This patient group is the target of the International Osteoporosis Foundation (IOF) Capture the Fracture campaign, advocating global adoption of fracture liaison services (FLS), with the aim of preventing secondary fragility fractures. We wished to determine the current availability and standards of an FLS in Ireland, ahead of the launch of a National FLS database.

Methods

We devised a questionnaire encompassing the thirteen IOF standards for an FLS and asked all 16 public hospitals with an orthopaedic trauma unit in Ireland, to complete for the calendar year 2019 in patients aged ≥ 50 years.

Results

All sites returned the questionnaire, i.e. 100% response rate. Nine hospitals stated that they have an FLS, additionally one non-trauma hospital running a FLS responded, and were included. These 10 FLS had identified and managed 3444 non-hip fractures in the year 2019. This figure represents 19% of the expected non-hip fragility fracture numbers occurring annually in Ireland. Implementation of the IOF standards was very variable. All sites reported being inadequately resourced to provide a high-quality service necessary to be effective.

Conclusion

The existence and functioning of FLS in Ireland are heterogeneous and suboptimal. A national policy to support the implementation of this programme in line with international standards of patient care is urgently needed.

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Data availability

All data was provided by each hospital from its own internal FLS database.

Hip fracture data are drawn from the publicly available Irish Hip Fracture Database.

Code availability

Not applicable.

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Author information

Authors and Affiliations

  1. Beaumont Hospital, Dublin, Ireland

    F. Dockery & E. Butler

  2. Our Lady of Lourdes Hospital, Drogheda, Ireland

    A. Glynn & B. Conlon

  3. Royal College of Surgeons in Ireland, Dublin, Ireland

    K. Franks & C. Fitzgerald

  4. University Hospital Galway, Galway, Ireland

    J. J. Carey

  5. University Hospital Waterford, Waterford, Ireland

    D. O’Gradaigh

  6. Connolly Hospital, Dublin, Ireland

    P. Kenny

  7. Tallaght University Hospital, Dublin, Ireland

    D. Askin

  8. St. Vincent’s University Hospital, Dublin, Ireland

    B. Sweeney

  9. Letterkenny University Hospital, Donegal, Ireland

    B. McGregor

  10. St. James’ Hospital, Dublin, Ireland

    R. Lannon

  11. Sligo University Hospital, Sligo, Ireland

    B. Rooney

  12. Tipperary University Hospital, Tipperary, Ireland

    I. Pillai

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  1. F. Dockery
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Corresponding author

Correspondence to F. Dockery.

Ethics declarations

Ethics approval

Each hospital consented to complete the questionnaire and share results. As a service evaluation, research ethics committee approval was deemed not necessary.

Consent to participate

As above.

Consent for publication

As above.

Competing interests

Frances Dockery, Aaron Glynn, Kenny Franks, John J Carey, Paddy Kenny, David Askin, Elaine Butler, Breeda Sweeney, Bernadette Conlon, Bruce McGregor, Rosie Lannon, Bridie Rooney, Isweri Pillai, Clare Fitzgerald declare that they have no conflict of interest. Donncha O’Gradaigh declares that he has a conflict of interest on being in receipt of educational grants from Amgen, UCB and Abbvie within the past 5 years.

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Dockery, F., Glynn, A., Franks, K. et al. Fracture liaison services in Ireland—how do we compare to international standards?. Osteoporos Int 33, 1089–1096 (2022). https://doi.org/10.1007/s00198-021-06251-4

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