The Fracture Liaison Service Database (FLS-DB) is a new national audit commissioned by HQIP as part of the Falls and Fragility Fracture Audit Programme (FFFAP). The FLS-DB is included in the HQIP 2015/16 listing for national audits that must be reported both in the trust’s Quality Account and also form part of the National Clinical Audit Patient Outcomes Programme (NCAPOP).

The Fracture Liaison Service Database (FLS-DB) is a new national audit commissioned by HQIP as part of the Falls and Fragility Fracture Audit Programme (FFFAP) for the period of 2015 – 2017. The FLS-DB consists of a Organisational Audit and a Patient Audit. The anticipated time lines are below.

Organisational Audit
Aims to profile the structures and policies of services which identify patients at risk of osteoporosis and falls (whether or not they badge themselves as an FLS) in order to create a detailed national picture of how secondary prevention is being delivered. 

The organisational proforma can be downloaded below. Please note there are two versions - a full proforma for sites which have an FLS, and a shorter proforma for sites which do not have an FLS.

Open toAll healthcare providers who treat fragility fractures in England and Wales. You do not need to have an FLS.
Registration Now open
  • Please fill out a registration form 
  • return it to by 20 September 2015
Data collection 21 September – 16 October 2015
Reporting December 2015

Patient Audit
Aims to measure secondary prevention based on a continuous data collection of a minimum common dataset. 

Open to All healthcare providers in England and Wales that have an FLS – a service that systematically identifies eligible patients aged over 50 years who have suffered a fragility fracture and treats or refers them to appropriate services with the aim of reducing their risk of subsequent fractures
RegistrationTo register for the Patient Audit, please participate in the Organisational Audit.
Data collection January – September 2016
Reporting March 2017

Why participate?

Quality accounts

  • The FLS-DB is one of the three workstreams that make up the Falls and Fragility Fracture Audit Programme (FFFAP). FFFAP is part of the National Clinical Audit Patient Outcomes Programme (NCAPOP) and is included HQIP’s 2015/2016 listing for national clinical audits that must be reported in your trust’s Quality Accounts.

Care quality improvement

  • The FLS-DB aims to improve the quality of patient care by enabling NHS organisations to:
    • compare their outcomes of care with similar NHS organisations
    • identify and share best practice
    • identify gaps or shortfalls in commissioning services
    • provide a more comprehensive picture of fragility fracture care and outcomes.

Clinically led, evidence based

Who manages the audit?

The FLS-DB is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and delivered by the Royal College of Physicians (RCP), working with Royal College of Surgeons and National Osteoporosis Society.


Improving your FLS

  • Champions Network
    • The FLS Champions Network was initially set up as part of the FLS-DB and led by the RCP; it is now managed by the National Osteoporosis Society (NOS) who provide support to healthcare professionals on an interactive web-based forum, allowing members to share best practice in FLS and secondary fracture prevention.
    • Members of the network include all healthcare professionals that share a specialist interest in FLS. It is not a requirement to have an FLS to become an FLS Champion: some members are actively engaged in FLS, while others may join the network to gain a greater understanding and insight into FLS.
    • Please visit the NOS website to join.


  • FLS standards
    • The NOS has developed FLS clinical standards which provide the core standards that every FLS should meet to ensure that correct identification, investigation, information, intervention and integration with primary care are achieved, within a framework of quality, to the long-term benefit of fracture patients - the 5IQ approach. These have been endorsed by the RCP and the FLS-DB dataset is being developed to measure against these standards alongside the NICE guidance.



FLS-DB was commissioned in 2012 as part of the FFFAP with an initial objective of establishing whether it was feasible to establish a continuous national clinical audit of secondary fracture prevention – with a specific question of whether data from primary and secondary care could be combined to assess how effectively assessment and treatment for osteoporosis and falls is delivered across the care pathway.

The report can be downloaded here It describes a number of findings from this pioneering work:

  • Development of a model to estimate number of fragility fractures presenting to NHS providers.
  • Examining how effectively GP information systems identify the population who sustain a fragility fracture.
  • Using GP records to profile the how effectively patients are assessed and treated for osteoporosis and falls risk.
  • Identifying and matching records for the same fragility fracture from Fracture Liaison Service (FLS) and GP databases.
  • Examining whether practice level ‘opt-in’ mechanism can be used as the basis of a national database.

The report will also examine how the impact of changes to the information governance landscape in England over the period of this work has meant that, although the concept of linkage of records has been proven, we are not able to obtain sufficient volume of data to successfully deliver a primary-secondary care clinical audit in the immediate future.


Related links

National Osteoporosis Society - FLS toolkit

National Osteoporosis Society - FLS standards


Last updated on: 27 August 2015

Post new comment

Login to post comments