Efficacy and efficiency of fracture liaison services to reduce the risk of recurrent osteoporotic fractures.

BACKGROUND: Acting to prevent the next fracture after a sentinel fracture is support by the evidence base and brings benefits for patients, clinicians and healthcare systems. However, more patients after a fragility fracture remain untreated and vulnerable to future potentially life-changing fractures. Fracture liaison services (FLS) are models of care that can close this care gap. METHODS: A narrative review of the key evidence for the efficacy and effectiveness of FLS was performed RESULTS: There are few randomised control trials of FLSs and none with fracture as the primary outcome. Several observational studies have also demonstrated reductions in fracture, but most were limited by potential bias. Several studies have highlighted that not every FLS is automatically effective. CONCLUSION: Further research should focus on implementing effective FLS using published standards and only then exploring impacts on patient outcomes such as refracture rates.