Original Article

Osteoporosis International

, Volume 25, Issue 2, pp 701-709

First online:

Optimizing fracture prevention: the fracture liaison service, an observational study

  • D. A. EekmanAffiliated withDepartment of Rheumatology, VU University Medical Center Email author 
  • , S. H. van HeldenAffiliated withDepartment of Trauma Surgery, Isala Clinics
  • , A. M. HuismanAffiliated withDepartment of Rheumatology, Sint Franciscus Gasthuis
  • , H. J. J. VerhaarAffiliated withDepartment of Geriatric Medicine, University Medical Center Utrecht
  • , I. E. M. BultinkAffiliated withDepartment of Rheumatology, VU University Medical Center
  • , P. P. GeusensAffiliated withDepartment of Rheumatology, University HospitalBiomedical Research Institute, University Hasselt
  • , P. LipsAffiliated withDepartment of Endocrinology, VU University Medical Center
  • , W. F. LemsAffiliated withDepartment of Rheumatology, VU University Medical Center

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The response rate to the invitation to the fracture liaison service and reasons for non-response were evaluated in 2,207 fragility fracture patients. Fifty-one percent responded; non-responders were most often not interested (38 %) or were hip fracture patients. After 1 year of treatment, 88 % was still persistent and 2 % had a new fracture.


To increase the percentage of elderly fracture patients undergoing a dual energy x-ray absorptiometry (DXA) measurement, and to investigate why some patients did not respond to invitation to our fracture liaison service (FLS).


In four Dutch hospitals, fracture patients ≥50 years were invited through a written or personal invitation at the surgical outpatient department, for a DXA measurement and visit to our FLS. Patients who did not respond were contacted by telephone. In patients diagnosed with osteoporosis, treatment was started. Patients were contacted every 3 months during 1 year to assess drug persistence and the occurrence of subsequent fractures.


Of the 2,207 patients who were invited, 50.6 % responded. Most frequent reasons for not responding included: not interested (38 %), already screened/under treatment for osteoporosis (15.7 %), physically unable to attend the clinic (11.5 %), and death (5.2 %). Hip fracture patients responded less frequently (29 %) while patients with a wrist (60 %) or ankle fracture (65.2 %) were more likely to visit the clinic. In 337 responding patients, osteoporosis was diagnosed and treatment was initiated. After 12 months of follow-up, 88 % of the patients were still persistent with anti-osteoporosis therapy and only 2 % suffered a subsequent clinical fracture.


In elderly fracture patients, the use of a FLS leads to an increased response rate, a high persistence to drug treatment, and a low rate of subsequent clinical fractures. Additional programs for hip fracture patients are required, as these patients have a low response rate.


Fracture Fracture liaison service Osteoporosis Persistence Prevention Response