Division of Endocrinology & Diabetes

Fracture Liaison Services Focuses on Reducing Fragility Fractures in Older Patients

Vafa Tabatabaie MD Endocrinology Albert Einstein College of Medicine Montefiore Medical Center Bronx NY
Vafa Tabatabaie, MD

Falls among the elderly are common and dangerous, and fragility fractures impose significant care and cost burdens worldwide. One of every 2 women and 1 in every 5 men over 50 are expected to suffer a fragility fracture, and victims of these fractures are 2-5 times more likely to experience additional fractures.

Focus on Future Prevention

While primary prevention remains an important goal, avoidance of future fractures has recently become a focus, turning attention to “Fracture Liaison Services” (FLS), a patient-centered, coordinator-based model to reduce subsequent fractures through identification, intervention, and risk reduction. A number of FLS programs have been established throughout the United States, Canada, and UK over the past few years. Montefiore Health System’s own FLS program was initiated in January 2015 as a joint initiative between the Department of Medicine (Endocrinology & Diabetes and Geriatrics) and the Department of Orthopedic Surgery to provide responsible patient care, improve outcomes, and shift the focus from treatment to prevention of fragility fractures.

Spearheaded by Dr. Vafa Tabatabaie, Assistant Professor of Medicine (Endocrinology) and an endocrinologist with clinical and research interests in aging-related endocrine issues such as metabolic bone disease and osteoporosis, FLS “captures” patients who present with hip fractures for treatment at Montefiore Wakefield Campus. Identifying these patients is a critical step--studies show that nationwide only about 20% of these patients have traditionally received appropriate follow-up care.

"Aside from being costly to healthcare systems, fragility fractures result in pain, disability, loss of quality of life, and particularly for hip fractures, an increased risk of premature death," Dr. Tabatabaie said. "Effective care and proactive management of these patients' conditions can make a world of difference."

“Capturing” the Other 80%

At the Wakefield Campus hip fracture service, patients are screened for vitamin D deficiency, treated accordingly, and discharged with antiresorptive medication for osteoporosis when appropriate. Over 100 patients have been identified through the program since its inception. 

"Falls and bone health are closely linked and many future fractures may be prevented by addressing these issues together," said Dr. Tabatabaie.

This type of systems-based approach is efficient and cost effective for preventing secondary fractures. Hip fractures, which are particularly devastating, costly, and common in patients who have suffered prior fractures, are a target intervention. Though still young, Montefiore’s FLS builds on the success of endeavors like the Kaiser Permanente Healthy Bones Program in Southern California, which since 1998 has reduced the rate of hip and other fragility fractures by over 40% and helped prevent over 1000 hip fractures per year, resulting in a net savings of over $30 million annually.

A Wide Collaborative Net

The FLS program is strongly supported by leaders from the Department of Medicine and each of the related specialties—Dr. Laurie Jacobs, Interim Chair of the Department of Medicine; Dr. Neil Cobelli, Professor and Chair of the Department of Orthopaedic Surgery; Dr. Norman Fleischer, Professor and Chief of the Division of Endocrinology; Dr. Joe Verghese, Professor of Medicine (Geriatrics) and Neurology, Chief of the Division of Geriatrics, and Director of the Division of Cognitive & Motor Aging (Neurology); and Dr. E. Stephen Amis, Professor and Chair of the Department of Radiology. This backing has been instrumental in the success of the program’s launch. 

Dr. Tabatabaie plans to integrate additional departments involved in caring for patients with fragility fractures. “Our goal is to capture each patient who presents with any fragility fracture to Montefiore Health System’s emergency room, inpatient units, and supportive services such as rehabilitation and interventional radiology,” she said.

Dr. Tabatabaie will present the FLS implementation at the Department of Medicine Grand Rounds, Thursday, October 29, 2015, 8 am (Einstein campus) and 12:15 pm (Moses campus). Her talk is titled “Secondary Prevention of Osteoporotic Fractures: Closing the Treatment Gap”.

Posted October 25, 2015 

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