The fracture liaison service: its history, current state, how it works, and future directions

Osteoporotic fractures often result in reduced function after healing, with associated pain, disability, loss of independence, and reduced quality of life. Following osteoporotic fractures, it is common for older adults to sustain subsequent, or secondary, fractures. These fractures include those of the proximal femur, vertebrae, distal radius, proximal humerus, and other sites. Although widely recognized as a gap in care, the implementation of appropriate secondary fracture prevention programs has been carried out in most countries. A Fracture Liaison Service represents the best secondary fracture prevention model of care for managing osteoporosis following fragility fractures and falls. These programs have proven to be cost-effective, and represent a major advancement in patient care over those "usual care practices" seen in most community and academic medical centers. Key Fracture Liaison Service programmatic functions include case finding, patient assessment, osteoporosis assessment, initiation of osteoporosis treatment, falls prevention, education, and exercise.