ORIGINAL ARTICLE
Bes P ac ice F amewo k o F ac u e Liaison Se ices in Spain
and hei coo dina ion wi h P ima y Ca e
A. Na anjo
1
&S. Ojeda
1
&M. Gine
2
&M. Balcells-Oli e
3
&L. Canals
3
&J. M. Cancio
4
&E. Duaso
5
&J. Mo a-Fe nández
6
&
C. Pablos
7
&A. González
7
&B. Lladó
8
&F. J. Olmo
9
&M. J. Mon oya
9
&A. Menéndez
10
&D. P ie o-Alhamb a
11
Recei ed: 14 Sep embe 2019 /Accep ed: 22 Janua y 2020
#The Au ho (s) 2020
Abs ac
Summa y The coo dina ion o F ac u e Liaison Se ices (FLS) wi h P ima y Ca e (PC) is necessa y o he con inui y o ca e o
pa ien s wi h agili y ac u es. This s udy p oposes a Bes P ac ice F amewo k (BPF) and pe o mance indica o s o he
implemen a ion and ollow-up o FLS-PC coo dina ion in clinical p ac ice in Spain.
Pu pose To de elop a BPF o he coo dina ion o FLS wi h PC in Spain and o imp o e he con inui y o ca e o pa ien s wi h
agili y ac u es.
Me hods A S ee ing Commi ee selec ed expe s om se en Spanish FLS and ela ed PC doc o s and nu ses o pa icipa e in a
bes p ac ice wo kshop. Selec ion c i e ia we e an ac i e FLS wi h an iden i ied champion and p io con ac wi h PC cen es
linked o he hospi al. The main aim o he wo kshop was o e iew cu en FLS p ac ices in Spain and hei in eg a ion wi h PC.
A BPF documen wi h p ocesses, ools, oles, and me ics was hen gene a ed.
Resul s Spanish FLS consis s o a mul idisciplina y eam o physicians/nu ses bu wi h low pa icipa ion o o he p o essionals
and PC s a . E alua ion and ea men s a egies a e widely a iable. Fou desi ed s anda ds we e ag eed upon: (1) E ec i e
channels o FLS-PC communica ion; (2) minimum con en s o an FLS clinical epo and i s deli e y o PC; (3) adhe ence
moni o ing 3 mon hs a e FLS baseline isi ; and (4) ollow-up by PC. P oposed key pe o mance indica o s a e (a) numbe o
FLS-PC communica ions, including consensus p o ocols; (b) con i ma ion FLS epo ecei ed by PC; (c) medical/nu sing PC
appoin men a e FLS epo ecei ed; and (d) numbe o aining sessions in PC.
Conclusions The BPF p o ides a comp ehensi e app oach o FLS-PC coo dina ion in Spain, o p omo e he con inui y o ca e in
pa ien s wi h agili y ac u es and imp o e seconda y p e en ion. The implemen a ion o BPF ecommenda ions and pe o -
mance indica o acking will benchma k bes FLS p ac ices in he u u e.
Keywo ds F agili y ac u e .Seconda y p e en ion .FLS .F ac u e Liaison Se ice .Bes P ac ice F amewo k
Elec onic supplemen a y ma e ial The online e sion o his a icle
(h ps://doi.o g/10.1007/s11657-020-0693-z) con ains supplemen a y
ma e ial, which is a ailable o au ho ized use s.
*A. Na anjo
ana [email protected]
1
Depa men o Rheuma ology, Doc o Neg in Uni e si y Hospi al,
Las Palmas de G an Cana ia, Spain
2
Bone Me abolism Uni , Depa men o In e nal Medicine, “Vi gen
Maca ena”Uni e si y Hospi al, Se ille, Spain
3
Amgen, Ba celona, Spain
4
Ge ia ics Se ice, Cen e Sociosani a i El Ca me, Badalona Se eis
Assis encials (BSA), Ba celona, Spain
5
Ge ia ics Se ice, Igualada Hospi al, Ba celona, Spain
6
Ge ia ics Se ice, Coo dina o FLS Hospi al Clínico San Ca los,
Mad id, Spain
7
Ge ia ics Se ice, Complejo Asis encial Uni e si a io Salamanca,
Salamanca, Spain
8
F ac u e Liaison Se ice, Hospi al Son Lla ze , Mallo ca, Spain
9
F ac u e Liaison Se ice, “Vi gen Maca ena”Uni e si y Hospi al,
Se ille, Spain
10
F ac u e Liaison Se ice, Hospi al Vi al Ál a ez-Buylla,
As u ias, Spain
11
Nu ield Depa men o O hopaedics, Rheuma ology and
Musculoskele al Sciences (NDORMS), Uni e si y o Ox o d,
Ox o d, UK
h ps://doi.o g/10.1007/s11657-020-0693-z
/ Published online: 25 Ap il 2020
A chi es o Os eopo osis (2020) 15: 63
In oduc ion
Os eopo osis and i s associa ed agili y ac u es a e globally
common condi ions con ibu ing signi ican ly o mo bidi y,
mo ali y, and heal hca e spending, and hus cons i u e a majo
public heal h p oblem [1].
Acco ding o ecen s a is ics om he In e na ional
Os eopo osis Founda ion, wo ldwide, 1 in 3 women and 1 in
5 men o e he age o 50 will expe ience agili y ac u es in
hei li e ime [2]. In Spain, i was es ima ed in 2013 ha a o al
o 552,879 women and 161,922 men would su e agili y
ac u es in he nex 10 yea s [3].
Pa ien s expe iencing he i s agili y ac u e a e a a sig-
ni ican ly highe isk o subsequen ac u es [4]. Pe i- and
pos menopausal women wi h low auma ac u e ha e ap-
p oxima ely wice he isk o subsequen ac u es compa ed
wi h simila pa ien s wi hou ac u e [5]. Mo eo e , os eopo-
osis ea men s a e mo e cos -e ec i e when p esc ibed o
olde adul s wi h p io ac u e [6]. Thus, clinicians ca ing
o ac u e pa ien s mus conside op ions o seconda y ac-
u e p e en ion. In pa ien s a mode a e ac u e isk, bone
mine al densi y can help guide he apeu ic decisions. In in e -
en ional s udies aimed a imp o ing os eopo osis manage-
men a e a ac u e, bone densi ome y was used in a median
o 43% o pa ien s [7]. Howe e , in Spain, he use o bone
densi ome y (Dual ene gy X- ay abso ciome y) o ac u e
isk assessmen is limi ed [8]. Mo eo e , despi e he a ailabil-
i y o medica ions p o en o educe he isk o u he ac u es
[9], ewe han 20% o indi iduals who sus ain a agili y
ac u e ecei e such he apies wi hin he i s yea ollowing
he ac u e [10,11]. This esul s in a pe asi e wo ldwide
ea men and s a egy gap o seconda y ac u e p e en ion
[11,12]. The e a e mul iple con ibu o s o his la ge gap, such
as clinicians ailing o adhe e o ea men guidelines [11], he
low p io i y assigned o seconda y ac u e p e en ion by p i-
ma y ca e (PC) and hospi al physicians [13], and poo pa ien
adhe ence o ea men [11].
Faced wi h his si ua ion, in 2011, he F ac u e Wo king
G oup o he Commi ee o Scien i ic Ad iso s o he
In e na ional Os eopo osis Founda ion (IOF) published a po-
si ion pape on coo dina o -based sys ems o seconda y p e-
en ion in agili y ac u e pa ien s. The pape consolida ed
knowledge on he de elopmen , e ec i eness, and common
ac o s ha unde pin success ul clinical sys ems designed o
close he seconda y ac u e p e en ion ca e gap [14]. F ac u e
Liaison Se ices (FLSs) a e ca e coo dina o -based seconda y
ac u e p e en ion p og ammes ha sys ema ically iden i y
agili y ac u e pa ien s, hen assess, in es iga e, and ea
hem o unde lying os eopo osis as app op ia e [15]. They
a e a cos -e ec i e s a egy o educing he os eopo osis ca e
gap, e ac u e a e, and mo ali y [16,17]. A nu se coo dina-
o o o he p o essional ac s as liaison be ween he pa ien ,
hospi al eam, and PC physician, o ensu e con inui y o ca e
[13]. I e ec i e communica ion be ween he FLS and PC is
es ablished, PC physicians a e well placed and willing o man-
age os eopo osis ca e in he longe e m [12].
Howe e , in he cu en scena io in Spain, once he ac u e
has healed, he e is no clea e e ence as o who should unde -
ake he pa ien ’ssubsequen ollow-upandca e[18]. Exis ing
models o seconda y ac u e p e en ion mos ly come om
Anglo-Saxon coun ies [14,19–21] and mus be adap ed o
he speci ic local heal hca e en i onmen [18].
The aim o his p ojec was o de elop a Bes P ac ice
F amewo k (BPF) o FLS-PC coo dina ion in Spain, o gua -
an ee he con inui y o ca e o pa ien s wi h agili y ac u es.
Me hods
The Spanish Socie y o Resea ch on Bone and Mine al
Me abolism (SEIOMM) suppo ed a wo kshop o de ine and
s anda dise p ocesses, ools, oles, and me ics o FLS-PC
coo dina ion.
A li e a u e e iew ega ding cu en FLS p ac ices in
Spain was pe o med o in o m he wo kshop. Sea ches we e
made in in e na ional (PubMed) and na ional da abases
(MEDES, IBECS), as well as g ey li e a u e ( esea ch pub-
lished in non-comme cial o m, e.g. epo s, con e ence p o-
ceedings, o doc o al heses/disse a ions), up un il Decembe
2017. The sea ch s a egy ocused on he pa hology o in e es
(“os eopo osis”), ac u e as he main complica ion, and ea -
men managemen in FLS (Supplemen a y Table 1).
A S ee ing Commi ee was c ea ed wi h champions om
h ee FLS cen es in Spain and he UK (Hospi al D . Neg ín,
n= 2; NDORMS, n= 1). Champions (n= 9) and case man-
age s (n= 1) om se en consolida ed Spanish FLS we e in-
i ed o pa icipa e in a wo kshop, oge he wi h hei ela ed
PC doc o s (n=11) and nu ses (n= 8) (Supplemen a y
Table 2). Selec ion c i e ia o FLS pa icipa ion we e o ha e
an ac i e FLS, wi h a well-iden i ied champion, and o ha e
p io con ac wi h he PC cen es linked o he hospi al.
Du ing he wo kshop, each champion p esen ed cu en
p ac ices and connec ion model wi h PC in hei heal hca e
a ea. The FLS bes p ac ices ollowed by he S ee ing
Commi ee, and in o ma ion de i ed om he li e a u e e-
iew, we e p esen ed as key indica o s o he pe o mance
and coo dina ion o he FLS wi h PC.
Two discussion g oups we e eques ed o each a consensus
on he ela ionship be ween FLS and PC. One g oup ocused
on he communica ion be ween he FLS and PC, o ensu e he
clinical epo is comple e and eaches he PC cen e. The
second g oup ocused on he coo dina ion o PC doc o s and
nu ses when hey ecei e he clinical epo , and coo dina ion
wi h he hospi al o pa ien ollow-up. Du ing he i s ound
o discussions, he S ee ing Commi ee posed ques ions o
de ine bes p ac ice s anda ds and how hey should be
63 Page 2 o 7 A ch Os eopo os (2020) 15: 63
measu ed. Du ing he second ound, conclusions om each
discussion g oup we e deba ed. The expe s hen gene a ed
he i s d a o he BPF, e iewed he d a , made sugges-
ions, and app o ed he inal e sion o he BPF o FLS-PC
coo dina ion in Spain. The BPF, which includes he ecom-
menda ions p oposed and pe o mance indica o s, is p esen ed
below.
Resul s
Cu en p ac ices in Spanish FLS
Cu en p ac ices in Spanish FLS and hei coo dina ion wi h
PC a e p esen ed (Table 1), conside ing a Spanish excellence
FLS (FLS o he Hospi al D . Neg ín, a na ional e e ence wi h
as expe ise) and he o he se en FLS pa icipa ing in he
s udy (Supplemen a y Table 2).
FLS composi ion and pa ien iden i ica ion
FLS consis o a mul idisciplina y eam, mainly comp ised by
physicians om di e en special ies and nu ses (Fig. 1). Each
FLS uni iden i ies pa ien s wi h agili y ac u e h ough se -
e al pa hways. The main one is he eme gency lis , while o he
less common modes include pa ien lis s om heuma ology
se ices, o hoge ia ics, o PC.
Type o ac u es included
All FLS include hip ac u e, and mos o hem include e e-
b al ac u e, and ac u e o he adius and p oximal hume us.
E alua ion
All FLS eques a blood es o e alua e he pa ien ’scondi-
ion. Mos o hem also collec densi ome y and an X- ay o
he spine. Da a collec ed o a lesse ex en a e F ac u e Risk
Assessmen Tool (FRAX), nu i ional assessmen , all isk
scale, abecula bone sco e, o assessmen o unc ional
capaci y.
In e en ion
The FLS ollow di e en scien i ic c i e ia o de e mine he
in e en ion and p esc ip ion ecommenda ions o seconda y
ac u e p e en ion, including he NOF [22] and SEIOMM
[23] c i e ia. All FLS ecommend pha macological ea men
when app op ia e; and mos o hem gi e nu i ional ad ice;
make ecommenda ions abou li es yle and calcium and i a-
min D supplemen s; o include a all p e en ion se ice.
Recommenda ions on gai ehabili a ion, physical exe cise,
o occupa ional he apy a e less common.
Table 1 Cu en ac ions pe o med in Spanish FLS
Pa ien iden i ica ion
Eme gency lis Pa ien lis s om hospi al se ices O hopaedics Ge ia ics Plas e oom Func ional spinal uni
Rheuma ology O hoge ia ics PC
75.0% 37.5% 37.5% 37.5% 25.0% 25.0% 25.0% 25.0%
E alua ion
Blood es Densi ome y Spine X- ay FRAX Nu i ional assessmen Fall isk scale TBS Func ional capaci y assessmen
100% 87.5% 75.0% 37.5% 37.5% 37.5% 25.0% 12.5%
In e en ion
Pha macological ea men Nu i ional ad ice Li es yle ecommenda ions Calcium and i D ecommenda ions Fall p e en ion Gai ehabili a ion Physical exe cise Occupa ional he apy
100% 87.5% 75.0% 75.0% 62.5% 50.0% 37.5% 25.0%
Follow-up
Hospi al isi PC physician Phone Elec onic p esc ip ion
pla o m
75.0% 62.5% 37.5% 12.5%
Coo dina ion wi h PC
Clinical epo deli e y o PC Pa hway o egula
communica ion wi h PC
Pe iodic aining sessions in PC Liaison pe son
75.0% 75.0% 25% 25%
FRAX ac u e isk assessmen ool, TBS abecula bone sco e
Page 3 o 7 63A ch Os eopo os (2020) 15: 63
Follow-up
In mos FLS (75.0%), pa ien ollow-up is unde aken a hos-
pi al isi s ace- o- ace wi h he specialis (o hopaedics, ge -
ia icians, heuma ologis s, and in e nal medicine physicians).
Time o he i s ollow-up isi a ies among cen es, anging
om 1 mon h o 2 yea s, as well as he numbe o isi s ca ied
ou , om none o h ee in a yea . In 37.5% o FLS, gene al
ollow-up is also pe o med by he PC physician, while in
25.0% o FLS, ollow-up is exclusi ely pe o med in PC.
In some FLS, he pa ien is also moni o ed by elephone o
assess ea men adhe ence, and only he Spanish excellence
FLS also moni o s ea men adhe ence h ough an elec onic
p esc ip ion pla o m.
Coo dina ion wi h PC
Th ee-qua e s o FLS ha e an es ablished pa hway o con in-
uous coo dina ion wi h PC, whe he h ough e-mail/ elephone/
ax o i ual consul a ions. Howe e , a designa ed indi idual
o manage his coo dina ion is a ailable only in 25.0% o FLS,
being a suppo echnician o a case manage nu se.
Ano he means o communica ion wi h PC is he clinical
epo sen o he PC physician. In 83.3% o he cases, he
epo is sen di ec ly o he PC physician o deli e ed ia
he pa ien , and in 33.3% o cases, he epo is sha ed by
common so wa e used by he hospi al and PC.
Only 25.0% o FLS deli e aining sessions a PC cen es o
emphasise he impo ance o seconda y p e en ion, ea men
adhe ence, and unde s anding he epo issued by he FLS.
BPF s anda ds o he coo dina ion o FLS wi h PC
in Spain
Fou s anda ds we e ag eed upon: (1) E ec i e communica ion
channels be ween he FLS and PC; (2) minimum con en s o
he FLS clinical epo and i s deli e y o PC; (3) ea men
adhe ence 3 mon hs a e he isi o FLS; and (4) ollow-up
by PC doc o and nu se. Pe o mance indica o s p oposed we e
(a) numbe o FLS-PC communica ions, including consensus
p o ocols; (b) con i ma ion o he FLS clinical epo ecep ion
by PC; (c) medical and nu sing appoin men s in PC a e he
FLS epo ; and (d) aining sessions ecei ed in PC (Table 2).
Discussion
The os eopo osis ca e gap a e agili y ac u es is g owing
subs an ially. The eason his ca e gap exis s, and pe sis s, is
mul i ac o ial in na u e [15]. Lack o cla i y ega ding whe e
clinical esponsibili y lies has been iden i ied as a majo con-
ibu ing ac o [24]. Al hough ini ia ing ea men in he o -
hopaedic depa men and hen delega ing ca e o PC physi-
cians has been ecommended [25], simply delega ing ca e o
PC does no posi i ely in luence p o ision o app op ia e p e-
en a i e measu es no does i imp o e subsequen ac u e
p e en ion. This is because nei he o hopaedic su geons
who ea acu e ac u es no PC physicians who p o ide
long- e m heal hca e appea o be engaged in seconda y p e-
en ion [26,27]. I is he e o e impo an o mo i a e PC phy-
sicians o become mo e in ol ed in he managemen o low-
impac ac u es [26]. In e na ional ecommenda ions o sec-
onda y ac u e p e en ion ad oca e ha p ocesses should be
in place o ensu e eliable p o ision o long- e m managemen
o ac u e isk. In heal hca e sys ems wi h es ablished PC
in as uc u e, local PC mus be in ol ed in de eloping he
p ocesses ha hey will implemen o pos - ac u e ca e [15].
I is encou aging ha Spain is ac i ely c ea ing FLS o
seconda y ac u e p e en ion [28]. Spanish FLS pa icipa ing
in his s udy sha e common cha ac e is ics and pa e ns, such
as hei mul idisciplina y composi ion, ype o ac u es ea -
ed, and main pa hways o ac u e-pa ien iden i ica ion.
Howe e , hey di e signi ican ly in he ex en o e alua ion,
ou each o in e en ion s a egies, and he equency and
ou es o pa ien ollow-up. Mo eo e , se e al imp o emen
oppo uni ies exis in he coo dina ion wi h PC.
As p e iously desc ibed, he implemen a ion o FLS may
be limi ed by a lack o PC pa icipa ion [26]. In his con ex ,
s anda dised p ac ices a e needed o achie e e ec i e coo di-
na ion be ween newly c ea ed FLS and PC, and hus imp o e
he con inui y o ca e o pa ien s wi h agili y ac u es.
In gene al, he e is limi ed in o ma ion ega ding how he
coo dina ion be ween FLS and PC is pe o med and li le da a
abou he pe o mance o his communica ion. Chang e al. [29]
iden i ied se e al ea men gaps in cu en FLS and p o ided
ecommenda ions o bes p ac ice es ablishmen o u u e FLS
ac oss he Asia-Paci ic egion. Thei indings emphasise he
impo ance o PC physicians con inuing o p esc ibe ea men
and ensu e se ice emains con enien . In cu en p ac ice
wo ldwide, specialis s ely on PC o manage os eopo osis.
Howe e , PC doc o s ou inely do so only i ad ised by spe-
cialis s, and os eopo osis expe s—usually endoc inologis s o
heuma ologis s—ha e no eason o in e ac wi h he pa ien
pos - ac u e [28]. The in ol emen o o he specialis s, such
25.0%
25.0%
25.0%
25.0%
25.0%
25.0%
37.5%
37.5%
50.0%
62.5%
75.0%
87.5%
87.5%
Adminis a ion s a
Radiodiagnosis echnician
Nu i ionis
Physio he apis
In e nal medicine
Rehabili a ion
Hospi al pha macy
Case manage
Rheuma ologis
Nu se
PC (collabo a ion)
Ge ia ician
O hopaedic
Fig. 1 FLS composi ion
63 Page 4 o 7 A ch Os eopo os (2020) 15: 63
as ge ia icians, in he acu e ca e o elde ly pa ien s wi h ac-
u es (mainly hip ac u es) in “O hoge ia ic Uni s”,has
shown o imp o e seconda y ac u e p e en ion [30].
Ano he p o en solu ion o close he seconda y ac u e p e en-
ion ca e gap is o es ablish an FLS [15], necessa ily coo dina -
ed wi h PC, highligh ing he need o he de elopmen o a BPF
o his coo dina ion.
In he p esen s udy, ou BPF s anda ds we e p oposed o
add ess he main needs o FLS-PC coo dina ion in Spain: (1)
P omo ion o FLS-AP communica ion, (2) uni ica ion o FLS
clinical epo me ics, (3) sys ema ic con ol o he adhe ence
o ea men by he FLS, and (4) imp o emen o pa ien
ollow-up by PC.
The ou s anda ds we p opose ha e p e iously been epo -
ed as ele an issues in os eopo osis managemen . The FLS
coo dina o , who akes ca e o all aspec s o he p ocess (pa ien
iden i ica ion, in es iga ion, and he apeu ic in e en ion), is
esponsible o p o iding adequa e medical in o ma ion o PC
physicians. FLS expe s p oposed se en possible gene al com-
munica ion channels, anging om ace- o- ace mee ings o
elecommunica ion channels, such as he elephone o e-mail,
in line wi h gene al li e a u e ega ding communica ion sys ems
Table 2 Recommenda ions o hospi al FLS-PC coo dina ion and pe o mance indica o s
S anda d Recommenda ion Pe o mance indica o
1. FLS-PC communica ion p ocedu e
E ec i e FLS-PC communica ion allows PC
o ob ain cla i ica ion abou speci ic cases o
doub s ega ding he ecommenda ions issued
by FLS and main ain he in e en ion
p oposed, ensu ing con inui y o ca e o a-
gili y ac u e pa ien s
Means o communica ion:
•Consul an om he FLS: on-si e (pe iodic isi
o PC cen e) o i ual (online)
•Email add ess a ailable o consul a ions
•Regula mee ings (qua e ly) in he PC cen es
•De elopmen o consensus p o ocols ( e e al,
ea men ) wi h PC
•Ro a ion o PC physicians and nu ses in he FLS
•T aining sessions o heal h p o essionals in PC
by FLS membe s, wi h he pa icipa ion o PC
physicians
•P omo ion o he de ec ion o agili y ac u e
(including e eb al ac u e) in PC: medical
and nu sing medical eco d
•Numbe o on-si e and i ual consul a ions,
e-mails sen and doub s esol ed, mee ings,
p o ocols c ea ed, o a ions ca ied ou , and
ac u es iden i ied by PC
•Numbe o aining sessions o heal h
p o essionals held in PC
2. FLS clinical epo s
The FLS gene a es a clinical epo a pa ien
discha ge, which is sen o he PC physician
Minimum da a o include in he clinical epo :
•Pa ien a ilia ion (pe sonal da a and medical
his o y), p e ious ac u e, cu en ac u e,
u u e ac u e isk (DXA and FRAX wi h
DXA), blood analysis, and Spinal X- ay (i
pe o med)
•P e ious ea men , enal unc ion,
como bidi ies, o he , i.e. p e ious ad e se
e ec , glucoco icoids
•Pha macological and non-pha macological ec-
ommenda ions
•Numbe o epo s gene a ed by he FLS and
pe cen age ecei ed by PC
•Pe cen age o epo s wi h minimum da a
3. Adhe ence con ol by he FLS
Adhe ence o ea men should be con i med
a e he baseline isi
Adhe ence should be con i med by he FLSin he
i s 3 mon hs, by bo h elephone call and
elec onically, and documen ed in one o he
ollowing:
•FLS da abase
•PC medical his o y by he PC doc o /nu se
•Pe cen age o pa ien s con ac ed o adhe ence
in he i s 3 mon hs, calcula ed om he o al
numbe o pa ien s wi h indica ion o ea men
a ended in he FLS
•Pe cen age o adhe en pa ien s in he i s
3 mon hs, calcula ed om he o al numbe o
pa ien s wi h indica ion o ea men a ended
in he FLS
4. Pa ien ollow-up by PC doc o s and/o nu se
Follow-up should be pe o med wi hin
6 mon hs o eceip o he FLS epo in PC
and p omo ed h ough a aining plan. The PC
nu se and/o PC physician would be esponsi-
ble o he ollow-up
Means o ollow-up:
•Es ablish an au oma ic ale when he epo is
ecei ed in PC: appoin men wi h he doc o
and he nu se
•Educa ional wo kshops o pa ien s:
de elopmen o homogeneous and basic
ma e ial o pa ien s, inco po a ion o he PC
physicians, FLS membe s, PC nu ses and
physio he apis s in he aining sessions
•Pe cen age o pa ien s wi h a ollow-up o
ac u e in medical eco d (physician o nu se)
in he i s 6 mon hs
•Numbe o aining educa ional wo kshops o
pa ien s in PC
DXA bone densi ome y, FRAX ac u e isk assessmen ool
Page 5 o 7 63A ch Os eopo os (2020) 15: 63

in heal hca e [31]. An impo an seconda y ac u e p e en ion
s a egy elies on he FLS epo o PC wi h ea men ecom-
menda ions [7]. Ou BPF ecommends which i ems o include
in his epo and possible ways o deli e i o PC. Medica ion
adhe ence emains a pa icula challenge in os eopo osis [32],
wi h li le consensus on how o iden i y non-adhe en pa ien s
[33–35]. Ou BPF ecommends checking pa ien adhe ence o
ea men in he i s 3–4 mon hs a e he indica ion o ea -
men , by bo h elephone call and elec onic eceip .
Fo BPF implemen a ion in he se en FLS and hei PC
cen es pa icipa ing in he p ojec , a aining plan o PC will
be designed. I will encompass basic in o ma ion (os eopo osis,
seconda y p e en ion) and he BPF s anda ds. T aining sessions
will be deli e ed by he champion o he FLS and a de ined case
manage o he PC cen e. In his ega d, p o iding PC physi-
cians wi h in o ma ion on ac u e isk, os eopo osis, and ap-
p op ia e p e en a i e measu es in discha ge epo s has p o en
o be an impo an pa o seconda y ac u e p e en ion [17].
A e wa ds, a case epo o m will be designed acco ding o he
me ics es ablished in he wo kshop o moni o he implemen-
a ion and pe o mance o he BPF s anda ds. The pe o mance
indica o s will be eco ded qua e ly by he FLS champion and
nu se/case manage o each FLS and PC cen e.
Ou p oposed BPF will se e as a model o he c ea ion o
new FLS and as a guide o imp o ing exis ing ones.
Adhe ence o he ecommenda ions in ou BPF may imp o e
he managemen and ollow-up o pa ien s wi h agili y ac-
u e. O e all, he pe cen age o pa ien s su e ing om a new
ac u e could be educed and, he e o e, he di ec and indi-
ec cos s associa ed wi h he agili y ac u e lowe ed.
Limi a ions o he s udy
The s udy was conduc ed om he pe spec i e o Spanish
heal hca e p o essionals and he esul s migh no be ex apo-
la ed o o he coun ies. Howe e , he de elopmen o s an-
da ds o he coo dina ion FLS-PC in Spain is c ucial, gi en
he inc easing numbe o FLS c ea ed, and he esul s o he
s udy p o ide a guide o he op imal long- e m managemen
o pa ien s wi h agili y ac u es. Fu he ollow-up mus be
unde aken o demons a e he e iciency o he BPF in in-
c easing he compliance and long- e m a e o he apy
u ilisa ion.
Conclusions
Local and na ional p e en ion s a egies mus be pu in place
apidly o e e se he inc easing numbe o agili y ac u es
occu ing in Spain. The BPF p o ides a comp ehensi e ap-
p oach o he coo dina ion be ween FLS and PC in Spain, o
p omo e he con inui y o ca e in pa ien s wi h agili y
ac u es and imp o e seconda y p e en ion. The implemen-
a ion o he BPF in clinical p ac ice will p o ide eedback o
ongoing imp o emen o BPF s anda ds and o benchma k he
bes FLS in he u u e.
Acknowledgmen s This s udy was designed in collabo a ion wi h Neus
Vidal and Cla a Gabás, om Ou comes′10. W i ing assis ance was sup-
po ed by Amgen S.A. and p o ided by Cla a Gabás, PhD, om
Ou comes′10.
Funding in o ma ion The s udy was sponso ed by Amgen S.A.
Compliance wi h e hical s anda ds
This a icle does no con ain any s udies wi h human pa icipan s o an-
imals pe o med by any o he au ho s.
Con lic o in e es Na anjo A has ecei ed esea ch g an s om
Amgen, consul ing ees om UCB and has pa icipa ed in speake s’
bu eaus o Amgen and Lilly. Ojeda S has ecei ed esea ch g an s om
Amgen. Canals L and Balcells-Oli e M wo k a Amgen and hold s ock
in Amgen. Mo a-Fe nández J has ecei ed esea ch g an s om Amgen
and consul ing ees om Amgen, Lilly, and UCB-Pha ma. Lladó B has
ecei ed ees as a speake a medical sessions and mee ings o Amgen
and UCB, and as a speake a medical sessions o Lilly. Olmo FJ has
ecei ed consul ing ees om Amgen, UCB and Abbo . P ie o-
Alhamb a D has ecei ed esea ch G an s om Amgen, UCB
Biopha ma and Les Labo a oi es Se ie , and non- emune a i e posi-
ions; he depa men has ecei ed ees o consul ancy se ices om
UCB Biopha ma and o speake and ad iso y boa d membe ship se -
ices om Amgen. Gine M, Cancio JM, Duaso E, Mon oya MJ, Pablos
C, González A, and Menéndez A decla e no con lic o in e es s.
Open Access This a icle is licensed unde a C ea i e Commons
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