Osteoporosis International

, Volume 25, Issue 2, pp 701–709

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


    • Department of RheumatologyVU University Medical Center
  • S. H. van Helden
    • Department of Trauma SurgeryIsala Clinics
  • A. M. Huisman
    • Department of RheumatologySint Franciscus Gasthuis
  • H. J. J. Verhaar
    • Department of Geriatric MedicineUniversity Medical Center Utrecht
  • I. E. M. Bultink
    • Department of RheumatologyVU University Medical Center
  • P. P. Geusens
    • Department of RheumatologyUniversity Hospital
    • Biomedical Research InstituteUniversity Hasselt
  • P. Lips
    • Department of EndocrinologyVU University Medical Center
  • W. F. Lems
    • Department of RheumatologyVU University Medical Center
Original Article

DOI: 10.1007/s00198-013-2481-8

Cite this article as:
Eekman, D.A., van Helden, S.H., Huisman, A.M. et al. Osteoporos Int (2014) 25: 701. doi:10.1007/s00198-013-2481-8



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

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013