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The Fracture Liaison Service (FLS)

The Fracture Liaison Service (FLS) provides routine assessment to all men and women aged >50 years who present with a new low-trauma clinical fracture at any skeletal site to Accident & Emergency/Trauma/Orthopaedic fracture services. The FLS(Radiology) is an extension of the FLS model that provides the same package of osteoporosis assessment and management to fracture patients who are identified as having had a fracture (at spine or other sites) on X-rays requested by GPs or secondary care.

The Fracture Liaison Service (FLS) provides routine assessment to all men and women aged >50 years who present with a new low-trauma clinical fracture at any skeletal site to Accident & Emergency/Trauma/Orthopaedic fracture services.  “Low trauma” is defined as occurring in all contexts other than in RTA or in fall from above head height. 

The FLS is effected by Osteoporosis Nurse Specialists (ONSs) who undertake:

a) identification or “case-finding” of the patients who present with new fractures - whether their fracture is managed as an inpatient or as an outpatient &

b) post-fracture assessment of re-fracture risk & for osteoporosis to ascertain if treatment for prevention of secondary fractures is necessary.  The majority of patients attend a “one-stop” clinic run by the ONSs at which DXA is performed, blood samples are taken (where appropriate) and treatment for secondary fracture prevention is selected according to protocol, when necessary.  In addition, education regarding osteoporosis and fracture prevention are provided. Patients are directed to exercise programmes appropriate to their level of functioning. The FLS will also refer patients over 65 to the falls services if they have not already been referred by A&E.  The figure below briefly summarises the elements of the care package provided by the FLS.


The FLS(radiology)  is an extension of the FLS model that provides the same package of fracture risk assessment and management to patients who are identified as having had a fracture (at spine or other sites) on X-rays requested by GPs or secondary care clinicians.  The ONSs identify these fracture patients from X-ray reporting systems and invites them to attend for post-fracture assessment with DXA, or alternatively, they may start treatment without DXA (where appropriate according to protocol).  The FLS(radiology) process is summarised in the figure below. 

All patients who are seen by FLS and who start on treatment are invited to attend an educational afternoon- (StaffNet users only) - within 6 to 12 months of starting treatment; the purpose is to help patients to become more involved in their management through greater knowledge.


Who provides the FLS & / or FLS(radiology) services in the different locations?

Hospital contact information to follow.