Fracture Liaison Services and Secondary Fracture Prevention in Fragility Fracture Patients
DOI:
https://doi.org/10.5281/zenodo.22328032Keywords:
Fracture liaison service, Secondary fracture prevention, Fragility fracture, Osteoporosis treatment gap, Capture the FractureAbstract
Background: Fragility fractures predict further fractures and death, yet most patients never receive osteoporosis investigation or
treatment after an index fracture. Objective: To synthesise evidence on fracture liaison service (FLS) models and their effect on osteoporosis investigation, treatment initiation, secondary fracture incidence, mortality, and cost-effectiveness.
Methods: Narrative review of systematic reviews, meta-analyses, randomised trials, registry audits, and health-economic studies.
Findings: Coordinator-led "Type A" FLS models most reliably increase bone mineral density testing and treatment initiation, and
are associated with an approximately 30-46% relative reduction in subsequent fracture and modest mortality benefit. Return on
investment averages roughly ten-fold, and cost per quality-adjusted life-year gained falls well below conventional thresholds
across health systems. Adherence beyond twelve months and regional implementation remain uneven. Conclusions: FLS represent the most consistently effective secondary-prevention strategy for fragility fracture, though long-term persistence and global coverage require continued investment.
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