Interventions to reduce falls risk: Insights from the 3rd annual Irish Fracture Liaison Service Database National Report and Facilities Audit

Abstract Background Evidence shows that a recent fracture is the leading risk factor for another. The Irish Fracture Liaison Service (FLS) identifies assesses, treats and monitors those age 50+ years who present with a new ‘fragility’ (low-trauma) fracture. The Irish FLS Database reports on secondary fracture prevention standards across Ireland. Its 3rd national report with a facilities audit has been recently published. The International Osteoporosis Foundation’s “Capture the Fracture” framework provides 11 key performance indicators (KPIs), widely adopted by FLSs globally. Two of these KPIs address falls: falls risk assessment, and strength and balance exercise referrals, the latter being the leading intervention for falls prevention. Methods To examine the pattern of engagement in strength and balance programmes, data collected in 2023 from the 3rd Irish FLS Annual Report and Facilities Audit were analysed, focusing on referral patterns and access to strength and balance programmes, along with sixteen-week follow-up data where available. Results In 2023, FLS data showed that of 3,770 fragility fractures, 51% were assessed for falls risk by the FLS, i.e. only half the cohort, with rates varying from 2-90%. Of these, one third were referred or advised to self-refer to strength and balance programmes. At 16 weeks, only 56% were contactable. Of these, only 21% had started a programme, with four hospitals reporting no patient participation in exercise at 16 weeks. The facilities audit showed geographic disparity: five of six Dublin hospitals reported access to such programmes, while none of the FLS’s outside Dublin reported awareness, despite availability through councils and community organisations. Conclusion The Irish FLS’s show significant variability in access to, and awareness of strength and balance exercise programmes, particularly outside Dublin. The audit concludes that national strategies to improve access, referral pathways, and awareness are needed.