Fracture Liaison Services

Fracture Liaison Services, commonly known as FLS, are coordinator-based, secondary fracture prevention services implemented by health care systems for the treatment of osteoporotic patients.

The FLS is designed to:

  • Close the care gap for fracture patients, 80% of whom are currently never offered screening and/or treatment for osteoporosis
  • Enhance communication between health care providers by providing a care pathway for the treatment of fragility fracture patients

Structure

An FLS, made up of a committed team of stakeholders, employs a dedicated coordinator to act as the link between the patient and the orthopaedic team, the osteoporosis and falls prevention services, and the primary care physician.

The FLS will ensure all patients presenting with fragility fractures to the particular locality or institution receive fracture risk assessment and treatment where appropriate. The service will be comprised of a dedicated case worker, often a clinical nurse specialist, who works to pre-agreed protocols to case-find and assess fracture patients. The FLS can be based in secondary or primary care health care settings and requires support from a medically qualified practitioner, be they a hospital doctor with expertise in fragility fracture prevention or a primary care physician with a specialist interest.

The service structure for a UK hospital-based Fracture Liaison Service is illustrated below.

Evidence

In 2011, the Fracture Working Group of the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) published a position paper on coordinator-based systems for secondary prevention in fragility fracture patients. The paper consolidated knowledge of the development, effectiveness and common factors that underpin successful clinical systems designed to close the secondary fracture prevention care gap.

A systematic literature review found that two-thirds of such systems employed a dedicated coordinator who acts as the link between the patient and the health care system.

Published in 2012, the American Society for Bone and Mineral Research Secondary Prevention Task Force Report summarizes the evidence for various forms of FLS as the most effective intervention for secondary fracture prevention. These major international initiatives underscore the degree of consensus shared by professionals throughout the world on the need for FLS to be adopted and adapted for implementation in all countries.

Overview of an FLS

A review on setting-up coordinator-based, post-fracture models of care provides a useful initial overview of FLS and how they work.

Publications describing successful programmes from the following countries provide visitors with practical insights regarding how effective models of care have been established throughout the world: Australia, Canada, France, Ireland, Northern Ireland, Singapore, Spain, Switzerland, The Netherlands, United Kingdom, United States of America.