Bone Abstracts

Background: The Aneurin Bevan Fracture Liaison Service (AB-FLS) sought to strengthen secondary fracture prevention in line with the Royal College of Physicians Falls and Fragility Fracture Audit Programme (FFFAP) 80/50/80 standards. Baseline audit using the Fracture Liaison Service Database (FLS-DB) identified poor case ascertainment as the major system failure, with only 22.7% of fragility fractures identified in 2021. A staged improvement plan aimed to reach 80% identification by 2030, alongside ≥50% treatment initiation and ≥80% follow-up.

Methods: A quality improvement approach using the Model for Improvement and iterative PlanDoStudyAct (PDSA) cycles was applied. Process mapping identified fragmented workflows and limited cross-specialty collaboration. In partnership with Radiology, a digitally enabled pathway was developed, replacing multi-step referrals with automated weekly case finding using the keyword fracture in radiology reports for patients aged 50 years. The programme aimed to increase identification by approximately 10% annually.

Results: Following PDSA evaluation, age thresholds were aligned with local falls pathways: patients aged 65 years were managed by Rheumatology and those ≥65 years by the Care of the Elderly team. Fragility fracture confirmation followed a two-stage process comprising electronic record review and structured telephone assessment of the mechanism of injury by a specialist Bone Health Nurse. Identification improved from 22.7% (2021) to 41.1% (2022). Expansion of capacity (Band 7 Nurse) in 2023 increased identification to 58.4%. Ongoing national FLS-DB audit and feedback informed further refinement, with identification rising to 70% (2,617 cases) in 2024 and achieving 80% (3,015 cases) in 2025, double the national benchmark of 40% and five years ahead of target. Treatment initiation exceeded 70%, and follow-up rates tripled, demonstrating sustained clinical impact and equitable access.

Conclusion: This quality improvement programme strengthened cross-divisional collaboration between Radiology, Rheumatology, and Care of the Elderly, delivering substantial improvements in fragility fracture identification and outcomes. The results secured stakeholder support and approval of the full FLS business case, reinforcing the principle of secondary prevention: Let the first fragility fracture be the last. Building on this success, the next step is to spread and scale the initiative to deliver consistent, equitable fragility fracture care nationally.