How to initiate and develop Fracture Liaison Services (FLS). Recommendations from the IOF Capture the Fracture® FLS Mentors in Brazil.

Expected number of fragility fractures in Brazil, raising the healthcare prioritization for interventions that reduce fracture risk. An FLS is dedicated to managing patient with fragility fracture to reduce risk of another fracture. We review FLSs cost-effectiveness and describe key components to effectively set up FLS in Brazil. PURPOSE: To create a guideline to show health professionals, hospital managers, and stakeholders in Brazil the importance of secondary fracture prevention and how to implement a Fracture Liaison Service. METHODS: We review the cost-effectiveness for FLSs in Brazil. We describe the key components needed to set up an effective FLS including methods for identification, investigation, treatment indication, including bone drugs, supplementation, physical activity, fall prevention, and monitoring. The staffing of FLSs, value of regional clinical networks and quality improvement are also described as a guide for healthcare professionals and decision makers in Brazil. RESULTS: An FLS is a service dedicated to identifying, assessing, recommending treatment, and monitoring patient who present with a fragility fracture reducing the risk of another fracture. FLS has been implemented in Brazil since 2012 overcoming a large geography and a complex health system. Even the limitations, restrictions, differences, and characteristics of each region, it is possible for health institutions to initiate an FLS, adapted to own available resources and meet the stages of identification, investigation, treatment, and monitoring. CONCLUSION: The peculiarity of the Brazilian healthcare system means FLS implementation needs to be tailored to local reality. However, even with limitations, any attempt to capture patients who suffer a fracture due to bone fragility is effective and reduces the risk of further fractures.

Avaliaçäo da acurácia da determinaçäo da idade óssea e de sua aplicaçäo na projeçäo da discrepância final do comprimento dos membros inferiores / Accuracy of bone age determination and its application in the final discrepancies projection in the lengh of lower extremities

Num estudo transversal, controlado, aleatório e encoberto, as radiografias de mäo e punho de um grupo de dez pacientes foram avaliadas por quatro examinadores, para determinaçäo da idade óssea, e aplicadas ao gráfico de Moseley, para projeçäo da discrepância final. Encontrou-se diferença significativa na comparaçäo da diferença de idade óssea pelos quatro examinadores entre as duas etapas. O limite de tolerância de +6 e +12 meses foi extrapolado, respectivamente em 34 e 12 por cento das determinaçöes. Näo houve diferença quanto às discrepâncias finais projetadas. Todas, exceto uma das projeçöes, ficaram dentro do limite de -2 centímetros a +1 centímetro. A determinaçäo da idade óssea utilizando-se o atlas de Greulich & Pyle tem pouca acurácia. Aparentemente, o gráfico de Moseley tende a minimizar as grandes dispersöes encontradas na determinaçäo da idade óssea, levando a uma aproximaçäo na projeçäo da discrepância final dos membros inferiores.