Bone Abstracts

Background: Fracture Liaison Services (FLS) face multiple compounding pressures including manual case finding, workforce constraints and delayed fracture identification, leading to missed opportunities for early intervention to reduce the risk of further fragility fractures.

Methods: We implemented a digitally enabled platform, RedStar FLS, to address delays and inequitable case finding within osteoporosis care. This platform is based on automated radiology case finding using text-based analysis of imaging reports, near-real-time surfacing of eligible patients onto a clinician dashboard and single-screen clinical decision support. This platform improves workflow and task management, ensuring patients are visible, tracked, and actioned. In parallel to digitalisation, recognising that those with vertebral fractures and hip fractures are at very high fracture risk (VHFR), a protocol for DXA prioritisation was introduced. We also implemented two new treatment pathways a pharmacist-led zoledronic acid pathway and an anabolic treatment pathway to address the need to treat VHFR patients within 12 weeks of DXA.

Results: RedStar FLS transformed fracture identification from a largely manual process into a near-real-time digital pathway, identifying eligible patients within an average of three days. Without an increase in staffing, FLS enrolment was doubled to 6,000 patients annually, freeing up around 50% of specialist nurse time and enabling consistent prioritisation of VHFR patients. We have observed a 10% reduction in hip fractures compared with baseline at a time when rates were rising elsewhere.

Conclusion: Prior to digitalisation, it could take 1524 months for some patients particularly those with vertebral fractures to be identified by FLS, undermining the clinical effectiveness of secondary fracture prevention. Digitalisation allows those with vertebral fractures to be systematically prioritised rather than incidentally managed. Although precise cost-effectiveness modelling is challenging in real-world services, we have demonstrated that an effective FLS can avoid high-cost hip fracture care and that digitalisation of FLS is feasible, scalable, and impactful, even in a constrained workforce environment. For those seeking to improve secondary fracture prevention, reduce unwarranted variation, and maximise existing clinical capacity, digital FLS represents a high-value system intervention.