FLS Stakeholder Roles

THE CHAMPION

Initial setup of a FLS program requires one individual to champion the development and implementation of the program. The champion will lead the development of the FLS business plan, engage with local administrators to seek funding and support of the service and provide ongoing clinical leadership to the FLS. The lead clinician for osteoporosis and fracture prevention should be well placed to be the champion for establishment and leadership of a FLS.

Although the champion’s specialty will vary, most FLS Champions are osteoporosis specialists, such as:

  • Orthopedic surgeons are central to the successful implementation of a FLS program. An orthopedic surgeon may play the role of FLS champion as described in the osteoporosis specialists’ section above. In the event that a clinician from another specialty leads the development of the FLS, representation of orthopedics in the multi-disciplinary stakeholder group is essential. 

  • Geriatricians: Geriatricians have a major role to play in the successful implementation of a Fracture Liaison Service. A geriatrician may play the role of FLS champion, but no matter what representation of geriatrics in the multi-disciplinary stakeholder group is essential. Comorbid conditions will often be highly prevalent among older fracture patients in general, and hip fracture patients in particular. Geriatricians’ expertise will be central to maximizing improved health outcomes for frail and vulnerable older people with fractures. 

  • Primary Care: Since osteoporosis is described as a long-term condition with acute exacerbations in the form of fragility fractures, the primary care team clearly has a crucial role to play after the fracture patient has been assessed by the FLS and any osteoporosis treatment has been initiated. Long-term conditions require long-term management plans, which primary care physicians are well placed to oversee. This would include a response to osteoporosis treatment-related side effects and consideration of comorbidities that may necessitate new treatments that could adversely impact bone health.  

  • Non-physician HCPs: Non-physician healthcare professionals (such as RNs, PAs, and NPs) have played a central role in delivering Fracture Liaison Services programs in the United States and internationally. The FLS coordinator is responsible for ensuring post-fracture patients receive appropriate diagnosis, treatment, and follow-up; this role can be filled by nurse practitioners, physician assistants, and registered nurses, among others. 

  • Healthcare administrators: Administrators of health systems and hospitals in the United States have supported clinical colleagues to establish successful and sustainable FLS programs. Another benefit of relevance to administrators is the potential impact a FLS can have to improve compliance with a number of quality measures related to osteoporosis and post-fracture care. Adopting the FLS model of care would translate into reduced health care costs in the short term and avoidance of penalties in the long term.

OTHER STAKEHOLDERS AND SUPPORTING ROLES

A factor common to all successful Fracture Liaison Service programs is involvement of a multi-disciplinary and multi-sector team of motivated individuals from the outset, all focused on ensuring that fracture patients receive high-quality care. The champions of successful and sustainable FLS programs should establish a multi-disciplinary stakeholder group from the project outset, which is likely to include:

  • Endocrinology, rheumatology, orthopedics, geriatrics, internal medicine, gynecology, care managers– typically one or more of these specialties will lead or co-lead the development of a FLS program

  • Pharmacy, radiology, physical therapy, physical medicine and rehabilitation, hospitalists, nephrology, and care management leadership– these specialties play a key, supporting role in the delivery of an effective FLS program

  • Departments of research, quality improvement professionals and hospital administrators (discharge planners, hospital utilization managers, finance)– these professionals will provide the FLS program with support on adhering to institutional research and care quality strategies, while early engagement with administrators will be essential to secure funding for the FLS through the crafting and implementation of a business plan