The overlooked burden of nonattendance in hip fracture liaison models of care

Maria Ortega Abad; Micaela Ebert; Judy Jin; Anokha Padubidri; Leila Zeinab Khan

doi:10.1093/jbmrpl/ziaf185

The overlooked burden of nonattendance in hip fracture liaison models of care

JBMR Plus. 2025 Dec 4;10(1):ziaf185. doi: 10.1093/jbmrpl/ziaf185. eCollection 2026 Jan.

Authors

Maria Ortega Abad¹, Micaela Ebert², Judy Jin², Anokha Padubidri³, Leila Zeinab Khan¹

Affiliations

¹ Endocrinology and Metabolism Department, Medical Specialties, Cleveland Clinic, Cleveland, OH 44195, United States.
² Department of Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
³ Orthopedics Department, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, United States.

Abstract

Fragility fractures are among the most serious complications of osteoporosis, associated with high morbidity, mortality, and long-term disability. Fracture liaison service (FLS) programs have demonstrated effectiveness in improving osteoporosis evaluation and reducing refracture and mortality rates. However, patient nonattendance remains a critical and underappreciated barrier to program success. At our institution, a hip FLS initiative showed a nonattendance rate of 68%, with only 7 patients initiating antiresorptive therapy. We review the multifactorial causes of nonattendance and propose targeted strategies to overcome these barriers, aiming to achieve effective secondary fracture prevention for all high-risk patients.

Keywords: barriers; fracture liaison service; fragility fractures; hip fracture; nonattendance.

Publication types

Review