Breaking the cycle of recurrent fracture: implementing the first fracture liaison service (FLS) in British Columbia, Canada

Arch Osteoporos. 2019 Nov 27;14(1):116. doi: 10.1007/s11657-019-0662-6.


Fractures occurring with very little trauma are often caused by osteoporosis and can lead to disability. This study demonstrates that a coordinator working with an orthopaedic team can significantly increase the number of individuals receiving appropriate treatments during their after-fracture care to prevent future fractures from occurring.

Purpose: Well-implemented Fracture Liaison Service (FLS) programs increase appropriate investigation and treatment for osteoporosis after low trauma fracture. This research evaluates the effectiveness of the first FLS program implemented in British Columbia (BC), Canada.

Methods: A controlled before-and-after study was conducted. The intervention was an FLS program implemented at an orthopaedic outpatient clinic at Peace Arch Hospital in BC. Eligible patients were those over the age of 50 years with a low trauma fracture of the hip, pelvis, vertebra, wrist or humerus. A nurse practitioner FLS coordinator identified, investigated and initiated treatment in patients based on their future fracture risk. The primary outcome was the percentage of all patients at high-risk to refracture, who achieved at least one of the following outcomes: (1) started on osteoporosis medication, (2) referred to an osteoporosis consultant or (3) assessed for treatment change if they were already on osteoporosis medication at the time of the fracture. Secondary outcomes included the rate of bone density testing, referral to fall prevention programs and change in health-related quality of life over 6 months.

Results: A total of 195 patients participated in the study (65 in the usual care group, 130 in the FLS group). Average age was 70.5 years (standard deviation 11.5), and 84% of participants were female. In the FLS group, 77.8% of high-risk patients achieved the primary outcome compared with 22.9% in the usual care group.

Conclusion: In BC, the implementation of an FLS program improved investigation and treatment for osteoporosis after low trauma fracture.

Keywords: Fracture Liaison Service; Fracture prevention; Older adult; Osteoporosis.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control
  • Aged
  • Aged, 80 and over
  • Bone Density / physiology
  • Bone Density Conservation Agents / therapeutic use
  • British Columbia
  • Delivery of Health Care, Integrated / organization & administration*
  • Drug Utilization / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis / diagnosis
  • Osteoporosis / drug therapy*
  • Osteoporosis / physiopathology
  • Osteoporotic Fractures / physiopathology
  • Osteoporotic Fractures / prevention & control*
  • Quality of Life
  • Recurrence
  • Secondary Prevention / organization & administration
  • Treatment Outcome


  • Bone Density Conservation Agents

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