Fracture Liaison Services - Polish Experience. Methods of Secondary Prevention of Osteoporotic Fractures.

BACKGROUND: Fragility fractures are a major challenge to health systems around the world. The risk of a subsequent fracture may increase even 11-fold after one's first fracture event. A coordinator-based system (Fracture Liaison Services) was established in Poland in order to fill the gap in the care of patients with osteoporotic fractures. In the past years, the FLS has become a crucial part of orthopaedic facilities worldwide, bringing benefits to patients and savings to health systems' budgets.

MATERIAL AND METHODS: In 2015, the European Foundation of Osteoporosis and Musculoskeletal Diseases (EFOM) implemented the FLS in Poland under the name "System Zapobiegania Złamaniom (SZZ)". It was established in 16 centres in different parts of Poland. During the preparation phase, 42 healthcare professionals from 17 sites participated in courses organized by EFOM.

RESULTS: A total of 1,579 patients were included in the SZZ, with a total of 746 DXA scans performed in that group. Patients were educated about osteoporotic fractures, including the methods of prevention (causes of fractures, problem of falls, vitamin D and calcium supplementation). The number of patients receiving antiresorptive treatment increased by 74.1%. The percentage of patients taking vitamin D and calcium supplements increased by an average of 10.8%. Although all the participating patients had suffered a fragility fracture, only 42% fulfilled the WHO clinical criteria for osteoporosis.

CONCLUSIONS: 1. The implementation of the Fracture Liaison Service concept in Poland is possible and beneficial for the patients and healthcare system. 2. The current WHO definition of osteoporosis might be insufficient. 3. The use of an integrated database in different facilities, in terms of fracture epidemiology, significantly improves the quality of data being collected.