Key points

Digitally enhanced fracture liaison services (DFLS) use software to automate key steps within a fracture liaison service (FLS), including patient identification, creation and circulation of patient letters and clinician reminders for patient reviews. By speeding up the administrative process, DFLS have the potential to reduce clinical workload as well as improving outcomes (preventing future fractures, reduced waiting times) due to earlier diagnosis of osteoporosis.

The evidence on the effectiveness of DFLS is limited in quantity and quality:

• We identified one published retrospective observational study, based in China, that compared routine fragility fracture management with a digitally enhanced fragility fracture management service. The digitally enhanced service contributed to improvements in reduced all-cause and fall-related mortality, reduced refracture and increased dual-energy X-ray absorptiometry (DEXA) testing and treatment initiation rates.
• Local audit data from a DFLS in NHS Greater Glasgow and Clyde (NHS GGC), analysed by the manufacturer RedStar^©, reported system improvements such as increased identification of fragility fractures and reduced scan backlog.
• We also identified one unpublished ongoing mixed-methods study and six ongoing service evaluations. No results are available for these studies.

We did not identify any evidence that looked at safety implications of DFLS, the cost-effectiveness of DFLS, or patient and staff views of DFLS. One economic study on the use of (non-digital) FLS may help to illustrate the potential benefits of a DFLS (that is, if the digital component helps to facilitate the effectiveness of an FLS).

Referred by

The Accelerated National Innovation Adoption (ANIA) pathway