Establishment of fracture liaison services in Germany

Abstract

Osteoporosis results in fragility fractures that are associated with ahigh morbidity and mortality as well as an increased risk for subsequent fragility fractures. Thus, the first fragility fracture should be the last. To achieve this goal patients need treatment of osteoporosis according to the prevailing clinical guidelines. This article presents the current clinical care situation of patients with amanifest osteoporosis in Germany and the accompanying risks. As apossible solution the concept of afracture liaison service (FLS) as anew intersectoral care concept is presented and options for the establishment of FLS in Germany are provided. Aliterature search (PubMed) was conducted using key terms. The practical experiences of the authors in the context of establishing an FLS were also considered. Compared to other countries, in Germany only aminority of patients receive treatment for osteoporosis after fragility fractures. To improve the care situation an intersectoral FLS provides acoordinated referral of patients with fragility fractures from inpatient care in hospitals to specialists in private practice. This enables the strict identification and treatment of high-risk patients according to the prevailing clinical guidelines. In Germany, different options exist to structure an FLS under consideration of the local circumstances. In Germany, FLS should be established nationwide and according to uniform standards. This would significantly improve the quality of clinical care of patients with manifest osteoporosis.