Closing the Treatment Gap: Implementing a Fracture Liaison Service in Public Healthcare A Case Study from Chile

Abstract

Osteoporotic fractures, especially of the hip and spine, entail significant morbidity and mortality, with a 50% increased risk of hip fracture following a prior fracture. Globally - and in Chile, a low rate of post-fracture osteoporosis treatment persists. The International Osteoporosis Foundation's "Capture the Fracture" initiative advocates optimal practices, including Fracture Liaison Services (FLS); however, in Chile, there are only two FLS, both in the private healthcare system. This study aims to implement the first FLS in the public domain, specifically at the Dra. Eloísa Díaz Clinical Hospital, at Santiago. The methodology is based on the Logic Model, emphasizing the importance of human resources, especially a coordinating nurse. The findings identify the problem, necessary resources, key actions, and short, medium, and long-term goals. External factors such as the hospital environment and collaboration with existing programs are considered. A graphical representation of the Logic Model is presented, along with proposed evaluation indicators. Addressing fragility fractures as a public health issue is pertinent, and hospital authorities' acceptance of our project for implementation is highlighted. This initiative is anticipated to inspire other public health centers in Chile to implement similar services, contributing to closing the treatment gap and enhancing patients' quality of life.