A Practical Guide to Fracture Liaison Services for Osteoporosis
Most people over 50 who break a bone never get evaluated for the osteoporosis behind it. Fracture liaison services close that gap with coordinated testing, treatment, and fall prevention — here's how they work.
How a Fracture Liaison Service (FLS) Program Works
Fracture liaison service osteoporosis programs exist to solve one of the most overlooked problems in bone health: most people who break a bone due to osteoporosis—a condition where bones become weak, brittle, and prone to fracture—never get treated for the underlying cause.
What is a Fracture Liaison Service (FLS) for osteoporosis?
A Fracture Liaison Service (FLS) is a coordinated care program that identifies people aged 50 and older who have broken a bone, evaluates their bone health, and connects them with the right treatment to prevent another break. Here is what that typically looks like in practice:
- You break a bone. A coordinator is notified and reaches out to you.
- You are assessed. Your bone density, medical history, fall risk, and lab work are reviewed.
- You receive a care plan. This includes treatment options, lifestyle guidance, and fall prevention support.
- You are followed up. A check-in happens within the first few months after your initial visit to make sure the plan is working.
This matters because the first fracture is rarely the last. Research consistently shows that the risk of another fracture is highest in the first two years after an initial break. And the care gap is real: multiple studies have found that fewer than 1 in 5 people with a fragility fracture are assessed and treated for osteoporosis afterward.
That gap in care is what FLS programs are designed to close.
Osteoporosis affects an estimated 3.5 million people in the UK and over 54 million Americans. Without a structured program like an FLS to follow up after a fracture, fewer than 25% of patients are ever diagnosed or treated for the bone disease that caused their break in the first place.
The sections below explain exactly how these programs work, who qualifies, what to expect at each stage, and where the biggest gaps in access still exist.
At its core, a fracture liaison service osteoporosis program is a team effort. Instead of leaving you to schedule multiple appointments with different doctors after breaking a bone, an FLS coordinator handles the details for you. This coordinator is usually a nurse practitioner or an advanced practice provider who specializes in bone health.
The coordinator acts as the bridge between different medical departments, such as orthopedic surgery (the doctors who fix broken bones), endocrinology (hormone and metabolism specialists), and your primary care physician. By working as a multidisciplinary team, these healthcare providers make sure you do not fall through the cracks after your bone heals.
This system is called a secondary prevention model. Primary prevention tries to stop a disease before it starts. Secondary prevention steps in after a major event, like a bone break, to prevent the next one. An FLS typically does this by identifying fracture patients, assessing bone health and fall risk, starting treatment when appropriate, and following up over time. Learn more about FLS models.
Who Qualifies and What to Expect During an FLS Visit
Generally, FLS programs are designed for adults aged 50 and older who have experienced a fragility fracture. A fragility fracture is a broken bone that happens from a low-energy event, such as falling from a standing height or slipping on a flat surface. In healthy bones, these minor impacts do not cause breaks.
To understand who qualifies, it helps to look at the different types of fractures. Doctors often group fractures into two main categories:
| Fracture Category | Common Sites | Impact on Osteoporosis Diagnosis |
|---|---|---|
| Major Osteoporotic Fractures (MOF) | Hip, spine (vertebrae), wrist, and shoulder | Highly likely to trigger an immediate osteoporosis evaluation. |
| Non-Major Osteoporotic Fractures (non-MOF) | Ankle, hand, foot, and leg | Often missed in standard care, but still highly linked to underlying bone thinning. |
Referral Criteria: Which Fractures Qualify
Historically, some programs only accepted patients who sustained a hip or spine fracture. However, clinical research shows a significant proportion of patients with non-major fractures also have thinning bones and qualify for treatment. Modern FLS guidelines recommend evaluating any patient over 50 who breaks a bone from a low-energy fall, regardless of the location of the break. Research on under-recognized fracture sites supports expanding these programs to protect more patients.
Bone Density Testing and Lab Work at Your First Visit
During your first FLS visit, the team will perform several assessments to get a clear picture of your bone health:
- Medical History: The coordinator will ask if you have lost height, if you have a family history of hip fractures, or if you take medications that thin your bones.
- DEXA Scan: A dual-energy X-ray absorptiometry (DEXA) scan is a quick, painless X-ray that measures how strong your bones are. It gives you a "T-score" to show if you have osteopenia (mild bone thinning) or osteoporosis (significant bone thinning).
- Physical Exam: The provider will check your posture and look for signs of unnoticed spine fractures, which can happen without pain and cause you to lose height.
- Lab Work: Blood tests are ordered to check your calcium levels, thyroid-stimulating hormone (TSH), and vitamin D levels. Your body needs adequate vitamin D — ideally above 30 ng/mL — to keep your muscles strong and help your bones absorb calcium. They may also look at bone turnover markers, which are proteins in your blood that show how fast your body is building or breaking down bone.
How FLS Programs Coordinate Care and Prevent Falls
Once your assessments are complete, the FLS team builds a personalized plan to protect your bones. This plan coordinates several areas of your health:
- Medication Management: If your bones are very thin, the coordinator may discuss prescription medications. These can include antiresorptive drugs (which slow down bone loss) or anabolic drugs (which help your body build new bone).
- Nutrition and Supplements: The team will help you adjust your diet to get enough calcium, vitamin D, and protein.
- Fall Prevention: Because most broken bones start with a fall, the coordinator will assess your fall risk. They may recommend home safety changes, vision checks, or a review of your current medications to ensure none of them make you dizzy.
- Exercise: Safe movement is vital for bone strength. The program will guide you toward weight-bearing and resistance exercises that make your bones stronger and improve your balance.
The core steps of this care coordination include:
- Systematic Identification: Finding patients over 50 with recent fractures.
- Investigation: Ordering DEXA scans and blood tests.
- Treatment Initiation: Recommending medications and supplements.
- Fall Prevention: Screening for fall risks and teaching balance exercises.
- Long-Term Monitoring: Following up at regular intervals across the first one to two years to support medication adherence and track progress.
For a deeper look at these standards, read the Guidelines on FLS essential elements.
The Benefits of FLS and Current Gaps in Care
FLS programs are highly effective. When a hospital uses an FLS, the number of patients who receive proper osteoporosis treatment increases more than two-fold. This coordinated care reduces the risk of breaking another bone, lowers post-fracture mortality (death) rates, and saves healthcare systems money by preventing costly subsequent fractures and hospitalizations.
Access to FLS programs still varies by region and hospital system. For older adults living in communities without a nearby hospital-based FLS, finding coordinated follow-up bone health care can be a challenge. If you are not automatically referred after a fragility fracture, take an active role — ask your orthopedic team, primary care clinician, or osteoporosis clinic about a DEXA scan, lab work, and treatment options. Expanding FLS coverage remains a major goal for bone health advocates, as research on FLS history and effectiveness shows these programs significantly improve outcomes when they are available.
Frequently Asked Questions About Fracture Liaison Services
How do I find a Fracture Liaison Service near me?
You can ask your primary care doctor or orthopedic specialist if your local hospital has an FLS program. You can also look at the International FLS network map to find participating medical centers and registries near your area.
Does Medicare cover FLS visits and treatments?
Yes, Medicare generally covers services related to osteoporosis management. Medicare Part B covers bone density scans (DEXA scans) once every 24 months for qualified, at-risk individuals, and it may cover them more frequently if medically necessary. Part B also covers outpatient doctor visits, coordinator assessments, and certain injectable osteoporosis medications if you meet specific clinical criteria.
What is the difference between an FLS and standard orthopedic care?
Standard orthopedic care focuses on the immediate crisis: resetting and healing the broken bone. Once the bone heals, orthopedic care usually ends. An FLS program looks at the bigger picture. It investigates why the bone broke in the first place and treats the underlying bone thinning so you do not experience another painful break in the future.
Protecting Your Bones After a First Fracture
A fracture liaison service osteoporosis program provides a vital safety net for anyone over 50 who has broken a bone. By coordinating medical care, bone density testing, medication, and fall prevention, these programs help you regain your independence and protect your future mobility.
If you do not have access to an FLS through your local hospital, Groove Health may help support your next step. Groove Health is a Medicare-covered online health program designed to bring coordinated osteoporosis support to you, without needing to travel to a clinic. Like an FLS, Groove Health focuses on reducing the risk of future fractures through practical, personalized care. You can connect with a physician for bone health oversight and work with a physical therapist who creates an exercise plan tailored to your needs. The goal is simple: build bone strength, improve balance, support safer movement, and lower fall risk from the comfort of your home. Check your eligibility for Groove Health today to take the next step in protecting your bones.
Works Cited
- Kates, S. L., and T. Miclau. "The Fracture Liaison Service: Its History, Current State, How It Works, and Future Directions." OTA International, 2022.
- Lagari, V. S., et al. "Under-Recognition of Fractures as Osteoporosis Indicators." Geriatrics, 2019.
- International Osteoporosis Foundation. "Capture the Fracture: International Fracture Liaison Service Toolkit." International Osteoporosis Foundation, 2014.
- Osteoporosis Canada. "Essential Elements for Fracture Liaison Services." Osteoporosis Canada, 2024.
- Le, H. V., et al. "Fracture Liaison Service—A Multidisciplinary Approach to Osteoporosis Management." Osteoporosis International, 2024.
- Bone Health & Osteoporosis Foundation. "Fracture Liaison Service (FLS)." Bone Health & Osteoporosis Foundation, 2024.
- Centers for Medicare & Medicaid Services. "Bone Mass Measurements Coverage." Medicare.gov, 2026.
This content is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare professional for diagnosis and treatment. If you are on Medicare and interested in a personalized bone health program, you can check your eligibility at groovehealth.com.
