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FLS-DB annual report 2021

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This is the fourth annual report for the Fracture Liaison Service Database (FLS-DB), providing national benchmarks performance across the care of people with fragility fractures in 2019. Please share your feedback on the report here.

Key recommendations

  • Without effective adherence, an FLS cannot reduce fracture risk or deliver expected improvements in patient outcomes. FLSs should use the 16-week follow up to personalise treatment recommendations according to patients’ needs and optimise adherence at 1 year.
  • Review performance across other parts of the FLS to establish whether vertebral fracture identification is the next priority for the FLS. If so, further recommendations on page 9 of the report.
  • Ensure that FLS staff time is dedicated to delivering at least one complete FLS quality improvement cycle in 2021–22. The aim should be to improve in one KPI while maintaining existing performance in other KPIs.

Please read the full report for recommendations for a range of audiences including services, commissioners, and executive teams.


Webinar recording available to watch: 

Full report


A fragility fracture is defined as a fracture following a fall from standing height or less. A fall from standing height or less should not normally result in a fracture, and thus should be identified and investigated by a fracture liaison service, as it may be a sign of osteoporosis. Osteoporosis is a condition which causes weakening of the bones. Therefore, people with osteoporosis are more likely to suffer fragility fractures.

If you, or someone you know has suffered a fragility fracture we have a number of resources for you.

This report has found improvement across most key performance indicators nationally, however further work is required for effective and efficient service delivery.

In 2020 we released the benchmark tables for services to use more recent data to inform their quality improvement priorities.

Local commissioners and FLSs should use this report to improve the effectiveness in post-fracture care delivery from existing FLSs through service improvement and additional commissioning to reduce the number of preventable fragility fractures in this high-risk patient group.

If your organisation (hospital, primary care practice, network and/or other community service) treats fractures you need to participate in the FLS-DB.