Osteoporosis International

, Volume 29, Issue 5, pp 1023–1047 | Cite as

Identifying characteristics of an effective fracture liaison service: systematic literature review

  • C.-H. Wu
  • C.-H. Chen
  • P.-H. Chen
  • J.-J. Yang
  • P.-C. Chang
  • T.-C. Huang
  • S. Bagga
  • Y. Sharma
  • R.-M. Lin
  • D.-C. ChanEmail author


Fracture liaison services (FLS) have been demonstrated to improve outcomes following osteoporotic fracture. The aim of this systematic literature review (SLR) was to determine the characteristics of an FLS that lead to improved patient outcomes. We conducted a SLR, including articles published between 2000 and February 2017, using global (Medline, EMBASE, PubMed and Cochrane Library) and local databases. Studies including patients aged ≥ 50 years with osteoporotic fractures enrolled in an FLS were assessed. Information extracted from each article included key person coordinating the FLS (physician, nurse or other healthcare professional), setting (hospital vs community), intensity (single vs multiple), duration (long vs short term), fracture type and gender. A meta-analysis of randomised controlled trials was conducted based on the key person coordinating the FLS. Out of 7236 articles, 57 were considered to be high quality and identified for further analysis. The SLR identified several components which contributed to FLS success, including multidisciplinary involvement, driven by a dedicated case manager, regular assessment and follow-up, multifaceted interventions and patient education. Meta-analytic data confirm the effectiveness of an FLS following an osteoporotic fracture: approximate 27% increase in the likelihood of BMD testing and up to 21% increase in the likelihood of treatment initiation compared with usual care. The balance of evidence indicates that the multifaceted FLS and dedicated coordination are important success factors that contribute to effective FLS interventions which reduce fracture-related morbidity and mortality.


Fracture liaison service Intervention Osteoporosis 



The authors would like to thank Dr. Zhongyun Zhao for facilitating this research and author collaborations.


This work was supported by Amgen Inc. Systematic literature review was conducted by Complete HEOR Solutions LLC and funded by Amgen Inc. Writing and editorial assistance was provided by ApotheCom and funded by Amgen Inc. and Gant from NCKUH (NCKUH-10609007, 10605021).

Compliance with ethical standards

Conflict of interest

Chih-Hsing Wu, Chung-Hwan Chen, Po-Han Chen, Jen-Jia Yang, Po-Chun Chang, Ting-Chun Huang, Yuvraj Sharma, and Ruey-Mo Lin declare that they have no conflict of interest. Shalini Bagga has ownership or partnership in Complete HEOR Solutions LLC. Ding-Cheng Chan receives consulting fees from Amgen, Inc.

Ethical approval

For this type of study, formal consent is not required.

Supplementary material

198_2017_4370_MOESM1_ESM.doc (156 kb)
ESM 1 (DOC 155 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • C.-H. Wu
    • 1
    • 2
  • C.-H. Chen
    • 3
    • 4
    • 5
    • 6
  • P.-H. Chen
    • 7
  • J.-J. Yang
    • 8
  • P.-C. Chang
    • 9
  • T.-C. Huang
    • 10
  • S. Bagga
    • 11
  • Y. Sharma
    • 11
  • R.-M. Lin
    • 12
  • D.-C. Chan
    • 10
    • 13
    • 14
    Email author
  1. 1.Department of Family MedicineNational Cheng Kung University College of Medicine and HospitalTainanTaiwan
  2. 2.Institute of GerontologyNational Cheng Kung University College of MedicineTainanTaiwan
  3. 3.Orthopaedic Research CenterKaohsiung Medical UniversityKaohsiungTaiwan
  4. 4.Department of Orthopaedics, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  5. 5.Division of Adult Reconstruction Surgery, Department of OrthopedicsKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
  6. 6.Department of Orthopedics, Kaohsiung Municipal Ta-Tung HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  7. 7.Department of Orthopedic SurgeryChang Gung Memorial HospitalYunlinTaiwan
  8. 8.Department of Internal MedicinePo Jen General HospitalTaipei CityTaiwan
  9. 9.Department of Orthopedics, An Nan HospitalChina Medical UniversityTainanTaiwan
  10. 10.National Taiwan University Hospital Chu-Tung BranchHsinchuTaiwan
  11. 11.Complete HEOR Solutions LLCNorth WalesUSA
  12. 12.Tainan Municipal An-Nan Hospital-China Medical UniversityTainanTaiwan
  13. 13.Department of Geriatrics and GerontologyNational Taiwan University HospitalTaipeiTaiwan
  14. 14.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan

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