This is the ninth annual report for the Fracture Liaison Service Database (FLS-DB).‘Steps to fracture liaison service effectiveness: importance of treatment recommendations’ provides national benchmark performance for the care of people with fragility fractures in 2024.
Steps to fracture liaison service effectiveness: importance of treatment recommendations
In England and Wales every year at least 347,770 people will break a bone after a fall from standing height or less. The Fracture Liaison Service Database (FLS-DB) captures the data of patients who have sustained fractures so it can be used to improve the quality of secondary fracture prevention and prevention more fractures.
This annual report presents the results of secondary fracture prevention care received by over 83,500 patients aged 50 and older following a fragility fracture between January and December 2024 from 77 FLSs.
In this year’s annual report, we focus on whether fracture patients and those at highest risk of osteoporotic fractures are prioritised and provided with appropriate treatment to prevent future fractures. In addition, we highlight the inequity in treatment access among FLSs, despite the presence of NICE guidelines on bone treatment.
Given the NHS prioritisation for prevention, community delivery and digitalisation, FLSs are encouraged to review their local pathways for high fracture risk patients. They are also encouraged to utilise NHS recommended quality improvement (QI) tools to improve service delivery and case finding of adults with higher risk fractures.
'This annual report celebrates the step change in secondary fracture prevention delivered through FLSs in England and Wales. The variability of care delivery between FLSs clearly demonstrates how FLS can be delivered effectively in the NHS. Our challenge now is to translate the effective care for some to effective care for all through data driven service improvement and service development using the shifts of prevention, community based care and digitalisation.'
Kassim Javaid, FLS-DB clinical lead
An exchange will be hosted on Thursday 29 January 2026 12.30 - 2pm to discuss the findings of the report. Please register to attend.
- Integrated care boards (ICBs) and Welsh health boards should support local FLSs in increasing patient identification, ensuring that both spine and non-spine fracture caseload identification by FLSs is 80% or above. Hip, spine, humerus, wrist and pelvic fractures should be prioritised by FLSs, as they have the higher
imminent fracture risk over other fractures. - ICBs and Welsh health boards should ensure that FLSs incorporate the NICE CG249 1.1.3 stage 1 falls assessment questions into all FLS assessments with clear signposting post assessment. This is with the aim of streamlining falls assessments across all FLSs and ensuring patients are provided with the appropriate treatment post fracture.
- ICBs and Welsh health boards should work with FLSs to ensure capability and capacity for FLSs to deliver bone therapy within NICE guidelines, including coordination across primary and secondary care.
- ICBs and Welsh health boards should ensure that FLSs are provided with sufficient capability and capacity to provide adequate care to those at the highest risk of a fragility fracture, as outlined in NICE guidelines.
- ICBs and Welsh health boards should support FLSs to ensure that a greater proportion of patients who have sustained a fracture receive a bone health assessment within 90 days, following the date of their fracture diagnosis.