What is the role of a Fracture Liaison Service (FLS)?

A Fracture Liaison Service (FLS) is a system aiming to ensure that fracture risk assessment, and treatment where appropriate, is delivered to all patients with fragility fractures. An FLS usually comprises a dedicated case worker (often a Clinical Nurse Specialist) who works to pre-agreed protocols to case-find and assess fracture patients. An FLS can be based in primary or secondary care and requires support from a medically qualified practitioner, be they a GP with specialist interest or a hospital doctor with expertise in fragility fracture prevention. In 2010, 37% of localities in England, Wales and Northern Ireland had an FLS whilst Scotland has almost universal access.

Where an FLS is established at the local hospital, this service can ensure that patients presenting with new fragility fractures receive the assessment they need immediately post-fracture. In some localities, a primary-care-based FLS has been established that operates by the nurse specialist providing a peripatetic service to local general practices to case-find prior fragility fracture patients and those at high risk of first fracture. Both approaches have been shown to close the care gap routinely evident in localities lacking an FLS. The National Audit of Falls and Bone Health in Older People 2010 provides information regarding access to FLSs by area.

Portsmouth FLS sign

Where an FLS is already in place, this service will help to support practices to achieve the quality of care required to meet osteoporosis Quality and Outcomes Framework indicators.

The NOS has recently produced a set of FLS Clinical Standards that provide the core standards that every FLS should meet to ensure that correct identification, investigation, information, intervention and integration with primary care are achieved, within a framework of quality, to the long-term benefit of fracture patients - the 5IQ approach

By adopting these standards, evidence-based best practice can be replicated effectively across the UK to reduce the burden of fractures while improving outcomes for patients and ensuring appropriate use of NHS resources.