The Impact of Fracture Liaison Services on Outcomes in Older Patients: A Systematic Review

Osteoporotic fractures are fractures caused by underlying osteoporosis that occur after minimal trauma. They represent a prevalent public health problem worldwide with significant economic burden and negative effects on quality of life. Fracture liaison services (FLS) are multidisciplinary programs aimed to decrease secondary fractures in high-risk patients by improving the post-fracture care gap. This review analyzes the impact of FLS on patient outcomes, especially refracture risk and osteoporosis medication initiation. This review was conducted using Ovid (MEDLINE), CINAHL, and Web of Science. Randomized controlled trials (RCTs), cross-sectional studies, observational studies, longitudinal studies, and cohort prospective/retrospective studies published between 2010 and 2024 were included. Selected articles also had a focus on refracture risk and/or osteoporotic medication initiation, a patient cohort mean age greater than 65 years old, and patients presenting with an initial osteoporotic fracture (as opposed to a history of fractures). Out of 727 total articles screened, 49 were included. The most prescribed medications were zoledronic acid, denosumab, and alendronate. FLS implementation was generally associated with a decrease in refracture rate, but only 11 out of 20 studies that assessed this found a statistically significant difference. Variability in refracture rates among studies may be due to differences in program intensity and patient demographics (namely, age and level of function). FLS can be an effective model to target the post-fracture care gap in older osteoporosis patients and improve outcomes, particularly medication initiation. Future studies should evaluate best practices for FLS programs.