Category: Best Practices for Multidisciplinary Care Coordination

21 - Secondary Fracture Prevention Programs: Experiences from the Field

Introduction: Establishment of a Fracture Liaison Service (FLS) results in significant improvement in fragility fracture patients receiving appropriate bone health counseling and treatment. Three clinicians: a RN, a NP, and a PA, share their perspectives and strategies for creating a successful FLS. Through their presentations, they examine their programs, including initiation, incremental growth over years, and current status, while also identifying implementation challenges and best practices.


Three clinicians established FLS programs utilizing the American Orthopaedic Association’s Own the Bone Program in an urban academic setting, a community-based regional hospital, and an integrated health system from 2010 to 2012. In each case, the FLS was started with the support of an orthopaedic physician champion for inpatient fracture patients over 50 years old. Over time, the programs were expanded incrementally to build referral networks, include outpatient fracture patients, and provide additional downstream services.

Through three different approaches and structures, each program has succeeded in increasing post-fracture osteoporosis education of inpatient and outpatient fragility fracture patients, resulting in expanded referral systems, capture of a larger population of fracture patients, and improved counseling and initiation of osteoporosis treatment.

There is no one model for a successful FLS program and cultivating a program takes time, but known best practices from other successful FLS programs can help institutions avoid recreating the wheel. These three case studies underline the importance of flexibility in establishing an FLS and in meeting the institution where it is. Implementing a successful FLS can help improve identification and treatment of osteoporosis and prevent recurrent fragility fractures.

Laura Boineau

Osteoporosis Coordinator
Greenville Health System/Department of Orthopaedics
Greenville, South Carolina

Amanda Brown, PA Bone Health/Fracture Liaison PA

Bone Health/Fracture Liaison Physician Assistant
Sanford Health Fargo, North Dakota
Fargo, North Dakota

Lynette R. Judy

Osteoporosis Coordinator
Jefferson Hospital Allegheny Health Network
Jefferson Hills, Pennsylvania