Case study: Fracture Liaison Service Database, UK

The Fracture Liaison Service Database (FLS-DB) monitors and assesses FLS performance in England and Wales.

Case study: Fracture Liaison Service Database, UK

What does the programme involve?

In England and Wales, the FLS-DB is a mandatory national audit programme managed by the Royal College of Physicians.1 Part of the national Falls and Fragility Fracture Audit Programme,1 the FLS-DB was first used in 2016 to audit secondary fracture services in England and Wales.2 It now assesses service performance against key indicators, and is the only audit of patient-level fracture prevention data in the world.1

What has the programme achieved?

The FLS-DB provides detailed insights into fracture care in England and Wales, which are used to guide service improvement efforts.3 The key finding of the first audit was that services varied in terms of resourcing, identification of cases, investigation of osteoporosis, falls assessment, treatment and monitoring after a fracture.2 In response, specific service improvement recommendations were produced,2 and subsequent reports have detailed how each FLS is performing against key indicators.4

Available data suggest that FLS are improving each year. The 2017 audit showed improvements against most key performance indicators compared with 2016 data. For example:

  • The proportion of people who were referred for a falls assessment increased from 40% to 46%.1
  • The proportion of people who were recommended osteoporosis medication increased from 38% to 43%.1

However, some indicators of long-term management regressed, highlighting important gaps in care.1

What lessons can be learnt from this programme?

National audits are instrumental in monitoring the performance of osteoporosis and fragility fracture services, identifying gaps in care and encouraging continuous improvement.5 Management of fragility fractures and prevention of subsequent fractures could be improved by implementing similar national programmes across Europe.

The information in this case study is based on research conducted for the 2020 publication Osteoporosis and fragility fractures: a policy toolkit.
Date of preparation: May 2022    UKI‑PRO-0621-00001
References +
  1. Royal College of Physicians. 2018. Fracture Liaison Service Database annual report: Achieving effective service delivery by fracture liaison services. London: RCP
  2. Royal college of Physicians. 2016. Fracture Liaison Service Database (FLS-DB) facilities audit. FLS Breakpoint: opportunities for improving patient care following a fragility fracture. London: RCP
  3. Gallagher C, Vasilakis N, Javaid K. 2019. Fracture Liaison Services in England and Wales, inequity of access and quality of care after a fragility fracture. Clinical Medicine 19(Suppl 2): 77
  4. Healthcare Quality Improvement Partnership. 2017. Fracture Liaison Service Database (FLS-DB) annual report. October 2017. Camerton: National Osteoporosis Society
  5. Ojeda-Thies C, Sáez-López P, Currie CT, et al. 2019. Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries. Osteoporosis International 30(6): 1243-54