Quality Improvement Initiatives in Fragility Fracture Care and Prevention

Curr Osteoporos Rep. 2019 Dec;17(6):510-520. doi: 10.1007/s11914-019-00544-8.


Purpose of review: This review sought to describe quality improvement initiatives in fragility fracture care and prevention.

Recent findings: A major care gap persists throughout the world in the secondary prevention of fragility fractures. Systematic reviews have confirmed that the Fracture Liaison Service (FLS) model of care is associated with significant improvements in rates of bone mineral density testing, initiation of osteoporosis treatment and adherence with treatment for individuals who sustain fragility fractures. Further, these improvements in the processes of care resulted in significant reductions in refracture risk and lower post-fracture mortality. The primary challenge facing health systems now is to ensure that best practice is delivered effectively in the local healthcare setting. Publication of clinical standards for FLS at the organisational and patient level in combination with the establishment of national registries has provided a mechanism for FLS to benchmark and improve their performance. Major efforts are ongoing at the global, regional and national level to improve the acute care, rehabilitation and secondary prevention for individuals who sustain fragility fractures. Active participation in these initiatives has the potential to eliminate current care gaps in the coming decade.

Keywords: American Society for Bone and Mineral Research; Asia Pacific Fragility Fracture Alliance; Capture the Fracture®; Fracture Liaison Service; Fracture prevention policy; Fragility Fracture Network; Fragility fracture; International Osteoporosis Foundation; Orthogeriatric Services; Osteoporosis; Secondary fracture prevention; Systems-based approach.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bone Density Conservation Agents / therapeutic use*
  • Disease Management
  • Humans
  • Osteoporosis / diagnosis*
  • Osteoporosis / drug therapy*
  • Osteoporotic Fractures / prevention & control
  • Osteoporotic Fractures / therapy*
  • Practice Guidelines as Topic
  • Quality Improvement*
  • Referral and Consultation*
  • Secondary Prevention


  • Bone Density Conservation Agents