Fragility Fracture Prevention-Implementing a Fracture Liaison Service in a High Volume Orthopedic Hospital

Int J Environ Res Public Health. 2019 Dec 4;16(24):4902. doi: 10.3390/ijerph16244902.


Fragility fractures pose a serious threat to patient health, quality of life, and healthcare sustainability. In order to reduce their clinical, social, and economic burden, a Fracture Liaison Service (FLS) was introduced in a high volume orthopedic hospital in 2017. The purpose of this retrospective observational study is to describe the FLS protocol, introduce its preliminary outcomes, and provide an early evaluation in light of international guidelines and recommendations. All the performances suggested by the International Osteoporosis Foundation (IOF) are provided under the same institution by which a patient is admitted for surgery. Clinical indicators from patient history and administrative indicators from the hospital database have been used to estimate the spread of fragility fracture prevention and the degree of patient compliance to these programs. The research included 403 patients. Although, almost 1/3 were admitted for the second fragility fracture, only half received anti-osteoporotic treatment before it. The degree of prevention was even lower in the case of patients admitted for the first fragility fracture. The risk of being affected by a secondary fracture was seven times higher when patients did not attend any follow-up or diagnostic exam. In order to identify the main determinants of compliance with FLS and perform a cost-effectiveness analysis on a larger sample, it is fundamental to integrate data from different providers.

Keywords: capture the fracture; endocrinology; fracture liaison service; fragility fracture; osteoporosis prevention; sustainability; value-based healthcare.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Hospitals, High-Volume*
  • Humans
  • Male
  • Osteoporotic Fractures / diagnosis
  • Osteoporotic Fractures / prevention & control*
  • Practice Guidelines as Topic
  • Program Evaluation
  • Quality of Life
  • Retrospective Studies
  • Secondary Prevention / methods*
  • Secondary Prevention / organization & administration
  • Treatment Outcome