Fracture Liaison services illustration
Credit: Tatiana Ayazo

As you age, your risk of developing osteoporosis, a condition that leads to thinning and weakened bones, increases. This can make your bones more susceptible to breaking or fracturing.

If you’re over 50 and experience a bone fracture or break, it’s important to receive comprehensive care that goes beyond just treating the injury itself. This is where fracture liaison services can be helpful.

What Are Fracture Liaison Services?

Fracture liaison services (FLS) were created to ensure anyone over the age of 50 who falls and breaks a bone gets adequate immediate and follow-up care. “The FLS model of care is the standard globally for what you need to do after someone has had a fracture to help prevent secondary or future fractures,” explains Claire Gill, CEO at the Bone Health and Osteoporosis Foundation.

Typically led by advanced practice health care providers who have received specialized training in FLS, the patient is matched with a team to receive proper evaluation, treatment, and education on preventing future fractures, adds Deena Adimoolam, MD, an endocrinologist who specializes in bone disease at Summit Health in Clifton, New Jersey.

An initial FLS visit typically includes:

  • A detailed medical history
  • A bone density screening (DEXA)
  • X-rays to check for fragility fractures of the spine
  • Lab testing to check vitamin D and calcium levels
  • Your FLS care team may also:

Discuss whether a rehabilitation program may help you

  • Prescribe osteoporosis medication to help prevent secondary fractures and promote bone health
  • Recommend lifestyle measures to strengthen bones, such as doing weight-bearing exercises and taking calcium and vitamin D supplements
  • Suggest home modifications to help prevent falls

A follow-up visit will likely be scheduled one to three months later to monitor how things are going and make adjustments to your treatment and management plan as needed.

How Do These Services Work?

“Once a patient has been admitted to the hospital with a fracture, the FLS is notified and will ensure the patient has a plan for evaluation to ensure the person is appropriately evaluated by various doctors,” explains Dr. Adimoolam.

These services extend well past your hospital stay. “A successful fracture liaison service will also check on the patients after follow-up to ensure they keep up with all discharge appointments.”

The Benefits of Fracture Liaison Services

“The goal of a FLS is to help patients maintain bone health and prevent future fractures,” says Dr. Adimoolam.”

Osteoporosis-related bone fractures are linked with:

  • Reduced mobility, even after healing
  • Increased levels of pain
  • Higher risk of disability
  • Loss of independence
  • Reduced quality of life

However, research shows that ever since FLS programs were first implemented in the early 2000s, they’ve helped:

  • Pinpoint proper osteoporosis diagnoses
  • Improve adherence to osteoporosis treatment
  • Reduce secondary fractures

Common Challenges with Fracture Liaison Services

According to Gill, FLS are often not implemented when they should be. When individuals over 50 with a fracture related to a fall are treated in hospitals, they typically receive treatment for the fracture and limited rehabilitation, but not necessarily FLS care. “They might get a little rehab, but that’s pretty much it — no one follows the FLS protocol,” says Gill. Unfortunately, studies show that only 20 percent of people who experience a fragility fracture, or a fracture related to a fall, receive osteoporosis treatment.

Gill uses the example of a heart attack to highlight how vital FLS services are. “After a heart attack, doctors put you on [medication], you get blood tests, you’re referred to a cardiologist; all of these protocols are put into place…and then someone would follow up with your primary care doctor and all of your other clinicians to make sure they were aware that this happened to you,” she explains.

FLS were created to ensure similar protocol and follow-up for bone breaks or fractures.

Even when FLS is in place, mistakes can still happen. Dr. Adimoolam notes that patients are often given pain medications that make them drowsy, which can make it hard for them to focus and remember all the details discussed with various doctors. That’s why it’s crucial to follow up with any questions you may have and ask for clarification if you’re unsure about next steps after a bone fracture.

Alternative Options for Fracture Liaison Services

If you don’t have access to a Fracture Liaison Service (FLS) but still want post-fracture care follow-up, there are several alternative options to consider. These include:

  • Talk to your primary care doctor: Your primary care doctor can help coordinate your post-fracture care and refer you to specialists, such as an endocrinologist or physical therapist, if needed. They can also help you develop a plan for managing your bone health.
  • See an endocrinologist: An endocrinologist specializes in bone health and can provide a “full evaluation for bone disease and treatment options,” says Dr. Adimoolam. They can also help you manage any underlying conditions that may be contributing to your fracture risk.
  • Seek out a physical therapist: Physical therapy is a great option for post-fracture care follow-up. A physical therapist can work with you to improve your strength, balance, and flexibility, which can help prevent future falls and fractures. They can also teach you exercises to help promote bone health and reduce your risk of future fractures.
  • Look for other community resources: Depending on where you live, there may be other resources available to help you manage your post-fracture care. For example, some hospitals or health systems have programs or clinics that focus on osteoporosis or fall prevention. You can also check with local senior or community centers to see if they offer any classes or workshops related to bone health.

Remember, it’s important to work closely with your health care provider to develop a post-fracture care plan that’s tailored to your individual needs. Don’t hesitate to ask questions and explore different options to find the support you need.

This article was made possible with support from Amgen. 

Bonanni S. The Role of the Fracture Liaison Service in Osteoporosis Care. Missouri Medicine. Jul-Aug 2017.

Bone Health & Osteoporosis Foundation. Fracture Liaison Service “FLS.”

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis.

Interview with Deena Adimoolam, MD, an endocrinologist who specializes in bone disease at Summit Health in Clifton, New Jersey

Interview with Claire Gill, CEO at the Bone Health and Osteoporosis Foundation.

Kates SL, et al. The fracture liaison service: its history, current state, how it works, and future directions. OTA International. June 2022.,_current.2.aspx.


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