Fracture Liaison Service (FLS) for secondary prevention of fragility fractures: the Italian IMPACT Project

Abstract

Osteoporosis and subsequent fragility fractures are an important public health issue since this is a common disease that leads to disability, and increased mortality, and therefore has a significant social and economic impact. Several studies have highlighted a dramatic diagnostic-therapeutic gap. A coordinated multidisciplinary system, known as the fracture liaison service (FLS) model, is the most appropriate approach for osteoporosis management and secondary prevention. Developed by the International Osteoporosis Foundation (IOF) through its Capture the Fracture campaign, the FLS model aims to avoid fragmentation of the care pathway by facilitating communication and coordination between primary care and medical specialists. The approach also involves patient identification and education, risk evaluation, the approval of treatments, and long-term follow up. The development of FLS programs has been strongly supported by the IOF. In Italy’s case, the primary recommendations made by the IOF in order to improve the management of patients with fragility fractures, and reverse the expected increase in the number of such fractures and their relative cost over the next 10 years, include the development of dedicated multidisciplinary care pathways, based on the FLS model. In order to make an effective contribution to the organizational needs in this regard, the primary objective of the IMPACT Project is to support the implementation and customization, in selected pilot centers in Italy, of an FLS model in line with the IOF recommendations and coherent with the Italian National Health Service (SNN), and to identify connection points with the territory, the activities of new healthcare professionals, and digital touchpoints in the care pathway.