Current Osteoporosis Reports

, Volume 11, Issue 4, pp 365–368 | Cite as

Commentary: The Five Ws of a Fracture Liaison Service: Why, Who, What, Where, and How? In Osteoporosis, We Reap What We Sow

  • Jeffrey R. CurtisEmail author
  • Stuart L. Silverman
The Why and How of Fracture Liaison Services (SL Silverman, Section Editor)


Establishing a Fracture Liaison Service (FLS) to identify and treat patients with a recent fragility fracture has been shown to be effective, save money, useful to document high quality of care, and makes good clinical sense. A FLS starts with an osteoporosis champion and encompasses identification of patients with a recent fracture, diagnostic workup, treatment, and follow-up. A FLS is most effective when it is able to function in multiple settings: the hospital, emergency department, and outpatient clinic. Implementation may be somewhat easier in a closed healthcare system but can be feasible even in an open system. There are many barriers to implementation which can be addressed. The future of FLS care lies in a collaborative systems-based approach with appropriate stakeholder engagement, leading to seamless integration of osteoporosis care.


Fracture Liaison Service FLS Osteoporosis management Fracture Risk Fragility fracture 


Compliance with Ethics Guidelines

Conflict of Interest

J Curtis declares that he has no conflicts of interest. SL Silverman declares that he has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Grace SC, Elliot MN, Giordino LA, et al. Health related quality of life and quality of care in specialized Medicare managed plans. Ambul Care Manag. 2013;36:72–84.CrossRefGoogle Scholar
  2. 2.
    Mitchell PJ. Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep. 2013;11:52–60.PubMedCrossRefGoogle Scholar
  3. 3.
    Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, et al. ASBMR Task Force on Secondary Fracture Prevention. Making the first fracture the last fracture: ASMBR ttask froce report on secondary fracture prevention. J Bone Miner Res. 2012;10:2039–46.Google Scholar
  4. 4.
    Dell R. Fracture prevention in Kaiser Permanente Southern California. Osteoporos Int. 2011;22 Suppl 3:457–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Newman ED. Perspectives on prefracture intervention strategies: the Geisinger Health System Osteoporosis Program. Osteoporos Int. 2011;22 Suppl 3:451–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Silverman SL. Measuring osteoporosis quality: the work of The Joint Commission. Curr Osteopor Rep. 2013. doi: 10.1007/s11914-013-0169-9 .
  7. 7.
    National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation; 2013. Available at: Accessed September 6, 2013.Google Scholar
  8. 8.
    Curtis JR, Kim Y, Bryant T, Allison J, Scott D, Saag KG. Osteoporosis in the home health care setting: a window of opportunity? Arthritis Rheum. 2006;55(6):971–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Becker DJ, Yun H, Kilgore ML, Curtis JR, Delzell E, Gary LC, et al. Health services utilization after fractures: evidence from Medicare. J Gerontol A Biol Sci Med Sci. 2010;65(9):1012–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Warriner AH, Outman RC, Saag KG, Berry SD, Colón-Emeric C, Flood KL, et al. Management of osteoporosis among home health and long-term care patients with a prior fracture. South Med J. 2009;102(4):397–404.PubMedCrossRefGoogle Scholar
  11. 11.
    Curtis JR, Arora T, Matthews RS, Taylor A, Becker DJ, Colon-Emeric C, et al. Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture vs death. J Am Med Dir Assoc. 2010;11(8):584–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Zhang J, Delzell E, Zhao H, Laster AJ, Saag KG, Kilgore ML, et al. Central DXA utilization shifts from office-based to hospital-based settings among Medicare beneficiaries in the wake of reimbursement changes. J Bone Miner Res. 2012;27(4):858–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Mitchell P. Fracture Liaison Service: the United Kingdom experience. Osteoporos Int. 2011;22 Suppl 3:487–94.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Clinical Immunology and RheumatologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Rheumatology, Cedars-Sinai Medical Center, David Geffen School of Medicine, and OMC Clinical Research CenterLos AngelesUSA

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