Setting up an osteoporosis fracture liaison service: background and potential outcomes

A large evidence base now exists for treatment interventions that will reduce fracture risk. However, the key area of practice now is how to get this evidence base into clinical practice. All health-care systems are subject to financial constraints, and therefore it is important that all areas of clinical practice can demonstrate that they are able to deliver care in a cost-effective manner. It has become increasingly recognized within the area of osteoporosis that treatment interventions should be targeted at patients at the highest absolute risk of fracture in order to maximize the cost-effectiveness of the service. One key subgroup of patients who are at higher absolute fracture risk are patients who present with an incident fracture. Although it has long been recognized that this is a key group to be considered for investigation and intervention, it is also clear that any form of structured care for this group has not been developed. This chapter will review the background and practical aspects of running a fracture liaison service. This service addresses the issue of secondary prevention of fracture while also considering both the absolute risk of fracture and the absolute benefit of the intervention. Issues relating to the background evidence base underpinning the service as well as the practical issues relating to the actual running of a service are discussed. Some of the potential service outcomes are also reviewed.