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 FLS-DB will comprise of two national audit components – a Facilities Audit and a Patient Audit. The Facilities 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.

This will be followed in 2016 with a national roll out of a clinical audit of secondary prevention based on a continuous data collection of a minimum common dataset.

The Facilities Audit will take place in autumn 2015. The dataset is currently be finalised, you can express your interest in participating by emailing

Feasibility stage

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 from the FFFAP webpage from 19 June 2015 and 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.


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.

Through participation in the audit, local services are able to benchmark their performance and identify where they are performing well, and improve the quality of treatment and care they provide. On a national level, wide participation in the audit also provides an overview of the quality of care being provided.

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.

How to participate

Facilities Audit

You are welcome to participate in the Facilities Audit even if you do not have a formal FLS. Please express your interest by emailing

Patient Audit

The participants of the 2016 Patient Audit will be drawn from, but not open only exclusively to, participants of the Facilities Audit. If you would like to participate in the Patient Audit, please take part in the Facilities Audit.

To be eligible to participate in the Patient Audit you need to have a service that systematically identifies all 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.

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.

Champions meeting

The next Champions meeting will be held in London on 19 June and is free to attend. Please visit the NOS website for more information.

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.

Related links

National Osteoporosis Society - FLS toolkit

National Osteoporosis Society - FLS standards


Last updated on: 13 July 2015

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