Long-term follow-up of patients in fracture liaison services: problems and solutions (literature review and own data)

To reduce the frequency of fragility fractures, Fracture Liaison Services are being created worldwide. One of the most difficult parts in their organization is considered to be the creation of an effective system of long-term patient management. Many factors are involved in this process, concerning the patient, the team of specialist, the peculiarities of the organization of primary health care, and many others. On the one hand, it has been shown that the inclusion of patients in FLS increases their commitment to the implementation of doctor’s recommendations. On the other hand, there are a number of barriers depending both on the characteristics of the patient himself (polymorbidity, severity of the condition, decreased cognitive function, fear of side effects, low motivation to treat osteoporosis) and on various aspects in the medical care organization. The article analyzes the importance of training patients and medical personnel, approaches to the choice of therapeutic tactics, optimization of the process of succession management of patients, the availability of a system of information exchange between medical institutions. Using the example of the Yaroslavl’ FLS, the possibilities of improving various aspects of medical care are analyzed, as well as local problems that arose at various stages of the development of this service, and the measures that were applied to resolve them.