Bone Abstracts

Background: Cardiff and Vale University Health Board (CaV UHB) has a long standing, successful fracture liaison service (FLS). The traditional model was reliant on physician led decision making; all patients fitting the local FLS inclusion criteria received a Duel Energy X-Ray Absorptiometry (DEXA), which were then vetted by a consultant. A FLS nurse then reviewed the patient in clinic. All cases were subsequently discussed with a doctor in order to create a clinical plan. Due to increasing demand and limited physician availability, this lead to bottlenecks in service delivery. Local pathways were not easily accessible and relied on individual health professional experience to remember guidelines and criteria for the service. This lead to variation in practice between health professionals and challenges when new staff joined the team.

Aim: To align services, within the limitations of current resources, with Royal Osteoporosis Society (ROS) clinical standards for FLS and the key performance indices of the Fracture Liaison Service Database: falls and fragility fracture audit programme (FFFAP).

Methods: An action group including physicians, FLS nurses, administration staff and management created local pathways based on ROS standards with a nurse led, doctor supported model in mind. A regular FLS MDT (comprising of nurses and a consultant) was set up to support clinical decision making and provide an opportunity for learning. Training to familiarise FLS staff with the new pathways was completed prior to rollout, with further areas of education identified for ongoing development.

Results: A nurse led, doctor supported FLS has been active since early 2026, more closely aligned with ROS clinical standards. CaV UHB approved pathways enable nurse led, guideline driven decision making with complex cases discussed in the FLS MDT. Benefits include a reduction in non-guideline driven DEXA requests, increased service resilience, more consistent decision making and an expanded FLS nurse skillset.

Conclusion: The FLS has evolved to meet the challenges of modern healthcare, however limitations still exist. These include insufficient administration support as well as limited registered non-physician prescribers and non-medical referrer qualified practitioners. Next steps include expanding services to address these challenges and monitoring progress on the FFFAP.