Fracture liaison service

This chapter reviews the evidence that a multidisciplinary structured program at a Fracture Liaison Service (FLS) is the most appropriate approach for the prevention of subsequent fractures in patients older than 50 years at high risk for additional fractures. It addresses the time-dependent risk of subsequent fractures, the diagnostic and therapeutic decisions to be considered based on a 5-step decision plan. Decision plan includes case finding, risk evaluation, differential diagnosis, therapy and follow up, and the implementation of a multidisciplinary organization and structured approach for secondary fracture prevention at the FLS. The presence of a combination of bone- and fall-related risk factors in most patients indicates that these risk factors should be evaluated in order to determine as accurately as possible the patient phenotype. Major challenges with all therapy for osteoporosis are initiation of treatment and longer term adherence.