Clinical Dialogue: Highlighting the Role of the Fracture Liaison Service in the Management of Patients with Osteoporosis

Osteoporosis is associated with significant morbidity and mortality in the aging population for both men and women, and its impact on the U.S. healthcare system is significant. Every year, over two million osteoporosis-associated fractures occur. The impact of fractures on patient quality of life is also significant; 85% of hip fracture survivors will need assistance to walk and 20% will require nursing home care. Despite the data that demonstrates that treatment significantly improves subsequent fracture risk among patients with a previous hip fracture, the opportunity to sufficiently treat patients after an osteoporotic fracture is largely underutilized. Post-fracture management of patients, through interdisciplinary services such as the fracture liaison service (FLS), started in the U.K. nearly two decades ago. These services were created to address the growing population with osteoporosis and those at risk of fragility fracture, as well as to address the low rates of work up and management of these patients in the post-fracture setting. Despite the presence of such programs, care for patients in the post-fracture setting remains suboptimal and gaps in the clinical management of these patients remain. Since the FLS is typically composed of an interdisciplinary team of orthopedic surgeons, primary care clinicians, endocrinologists and/or rheumatologists, and other ancillary clinicians, there are opportunities for PAs to participate at several points of care, both in orthopedic practices where they are well represented and in large primary care group practices where PAs can assume a leadership role.

Educational Objectives
At the conclusion of this activity, the PA should be better able to:
  • Outline the role of fracture liaison service and how PAs can participate in these programs.
  • Initiate pharmacologic therapies appropriately for patients who have experienced an osteoporotic fracture.
  • Discuss appropriate patient education in the post-fracture setting and facilitate hand-off for continuing care.
eCase Challenge and Monograph also available.