Fracture Liaison Service

In February 2018, ‘A Trauma System for Ireland: Report of the Trauma Steering Group’ recommended the establishment of a national Fracture Liaison Service (FLS). The National Clinical Programme for Trauma and Orthopaedic Surgery established the Fracture Liaison Service Steering Group in the same year, and in 2020, pharma funding was secured for a three-year period to establish a database and the role of a project manager.

What is a Fracture Liaison Service?

A Fracture Liaison Service is a system of healthcare whereby people who have suffered a fracture resulting from a low level of trauma (termed ‘fragility fracture’) are identified proactively, assessed, treated and monitored for osteoporosis and falls risk.

Fracture Liaison Services represent part of a comprehensive osteoporosis service which often includes primary prevention, assessment and management of complex conditions including investigations such as DXA scans. A Fracture Liaison Service can be considered a ‘secondary prevention’ service, provided to those following an initial fragility fracture, and addresses issues such as balance, muscle strength and falls risk reduction.

A Fracture Liaison Service is proven to reduce future fracture risk and is a cost-effective service that has been adopted globally to help tackle the burden of fragility fractures in an ageing population. The International Osteoporosis Foundation (IOF) has established evidence-based standards for all fragility fracture patients which are applicable worldwide and provide support and a framework for the development and audit of Fracture Liaison Service programmes.

A Fracture Liaison Service Database (FLS-DB) is essential to identify the number of patients at risk of fracture and to determine the extent to which these patients are being appropriately treated to reduce this risk.

What is the Fracture Liaison Service Database?

The FLS-DB is a clinically-led web-based national audit of secondary fracture prevention in the Republic of Ireland, which is managed by RCSI under the governance of the National Clinical Programme for Trauma and Orthopaedic Surgery.

The FLS-DB was established in 2020 and is an online portal managed by Crown Informatics Limited which collects data on non-hip fragility fracture patients. Crown Informatics Limited are the service providers for the UK Fracture Liaison Service and Hip Fracture Databases.

The first step in creating consistency and providing the best possible care for all patients is to have a baseline which identifies what care patients are currently receiving, which areas of the country have/don't have an Fracture Liaison Service, and how successful each service is at identifying, assessing, and treating those with osteoporosis following a non-hip fragility fracture.

The most common sites of fracture (hip fractures excluded from this database *2021) were:

  • Forearm: 36%
  • Spine: 22%
  • Humerus: 14%
  • Lower limb: 16%
  • Other: 12%

Clinical Leads

  • Joint Clinical Lead: Mr Aaron Glynn
  • Joint Clinical Lead: Prof. Frances Dockery
  • Joint National Clinical Lead for the NCPTOS: Mr Paddy Kenny

Hospitals (with a Fracture Liaison Service)

  • Beaumont Hospital
  • Connolly Hospital
  • Cork University Hospital
  • Our Lady of Lourdes Hospital Drogheda
  • Letterkenny University Hospital
  • Mater Hospital
  • Sligo University Hospital
  • St James’s Hospital
  • St Vincent’s Hospital
  • University Hospital Galway
  • Tallaght Hospital