The Effectiveness of Fracture Liaison Services in Improving Fragility Fracture Outcomes

Purpose of review Fragility fractures are associated with significant morbidity, mortality, and societal costs. A fracture liaison service (FLS) is a multidisciplinary approach that identifies people with fragility fractures with the goal to ensure optimal osteoporosis treatment. In this review, we summarize recent data on the FLS effectiveness in improving osteoporosis diagnosis, bone density testing, and osteoporosis treatment, as well as reducing the rates of secondary fragility fracture, subsequent fall, and mortality in individuals with fragility fractures. Recent Findings We identified one randomized controlled trial and ten observational studies published within the last 5 years that reported on relevant outcomes. FLS was associated with favorable outcomes, depending on the intensity of the FLS approach used. Secondary fragility fracture rate was the most common reported outcome. Most studies were conducted outside of the USA, included highly variable duration of follow-up and comparators, and focused on heterogeneous patient populations. Most recent studies of FLS have important limitations given the study design and risk of bias. Our findings support the need for randomized controlled trials of FLS in the USA to rigorously examine to what extent the implementation of FLS in the complex US healthcare system may improve outcomes of patients with fragility fracture.