By: 17 July 2015
Best Practice Framework is good benchmarking tool for fracture liaison services worldwide

Best Practice Framework is good benchmarking tool for fracture liaison services worldwide

New review finds Capture the Fracture Best Practice Framework helps raise standards, reinforce international guidelines, and identify challenges common to different health-care systems

A new review by the International Osteoporosis Foundation (IOF) has confirmed the success of the Capture the Fracture Best Practice Framework as a single set of quality standards which can be used effectively to benchmark Fracture Liaison Services (FLS) within a variety of health-care systems worldwide.

Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every three seconds. Among those at highest risk of fractures are individuals who have already experienced a first fracture.

Fracture Liaison Services (FLS) are coordinator-based, secondary fracture prevention services implemented by health-care systems for the treatment of osteoporotic patients. Proven to be the most effective and cost-saving method to identify high-risk individuals for secondary fracture prevention, they are nevertheless a challenge to initiate and run effectively. The Best Practice Framework (BPF) – 13 ambitious and achievable standards in implementing FLS – is intended as guidance and to provide a benchmark for FLS excellence.

In the first year of implementation by the Capture the Fracture programme, 60 FLS in 20 different countries were evaluated against the BPF.

Kristina Åkesson, chair of the programme, stated: “Over a comparatively short period of time, the impact of the BPF has been seen worldwide with several national societies using it as a framework for their guides and toolkits. The common set of standards has not only helped to set high quality standards and reinforce international guidelines, it has also enabled us to identify clear gaps and challenges which are common to FLS worldwide, irrespective of the health-care system.”

Findings after one year of evaluations against the Best Practice Framework

Overall, 43% of institutions which submitted their FLS for assessment against the 13 BPF standards reached gold, 39% reached silver and 18% reached bronze status. An analysis of the FLS assessments, published in Osteoporosis International, has revealed:

  • Services for hip fracture patients had the highest proportion of gold grading; vertebral fracture the lowest.
  • The majority of institutions achieved the gold level in each of the 13 standards, except for vertebral fracture identification and database.
  • The insufficient standard was most commonly assigned for the non-hip fracture domains, with 23% of institutions unable to identify all inpatients, 18% missing outpatients and 20% missing vertebral fracture patients.
  • 32% of institutions were not following up with patients within 12 months.

Source: International Osteoporosis Foundation


Javaid, M.K., Kyer, C., Mitchell, P.J., et al. (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework. Osteoporosis Int. doi: 10.1007/s00198-015-3192-0