Implementing and running a fracture liaison service: An integrated clinical service providing a comprehensive bone health assessment at the point of fracture management

The importance of screening adults who have fragility, atraumatic or low impact fractures for underlying osteoporosis has been highlighted in recent British Orthopaedic Association Guidelines and by The American Orthopaedic Association's 'Own the Bone' initiative. Fracture Liaison Services are an efficient way of managing patient screening in a population at high risk of osteoporosis. How a service might be devised, constructed and run in an acute Orthopaedic Unit is illustrated by reference to our own experience, in a UK Hospital serving a population of 320,000 and informed from our own audit data. We discuss the way that varying patient screening thresholds can be considered to focus resources and aim to provide information for those planning a Fracture Liaison Service within an Orthopaedic Unit. We also emphasise the existence of previously- undiagnosed occult conditions (in addition to osteoporosis) in patients < 75 years old presenting with fracture but disclosed by routine detailed laboratory tests. (C) 2008 Elsevier Ltd. All rights reserved.