Osteoporosis International

, Volume 25, Issue 2, pp 701–709 | Cite as

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

  • D. A. Eekman
  • S. H. van Helden
  • A. M. Huisman
  • H. J. J. Verhaar
  • I. E. M. Bultink
  • P. P. Geusens
  • P. Lips
  • W. F. Lems
Original Article



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 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • D. A. Eekman
    • 1
  • S. H. van Helden
    • 2
  • A. M. Huisman
    • 3
  • H. J. J. Verhaar
    • 4
  • I. E. M. Bultink
    • 1
  • P. P. Geusens
    • 5
    • 6
  • P. Lips
    • 7
  • W. F. Lems
    • 1
  1. 1.Department of RheumatologyVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Trauma SurgeryIsala ClinicsZwolleThe Netherlands
  3. 3.Department of RheumatologySint Franciscus GasthuisRotterdamThe Netherlands
  4. 4.Department of Geriatric MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
  5. 5.Department of RheumatologyUniversity HospitalMaastrichtThe Netherlands
  6. 6.Biomedical Research InstituteUniversity HasseltDiepenbeekBelgium
  7. 7.Department of EndocrinologyVU University Medical CenterAmsterdamThe Netherlands

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