Can Fracture Liaison Services Work in Primary Care? Lessons from an Australian Pilot Study
Traditionally, Fracture Liaison Services (FLS) operate directly within hospitals (linked to orthopaedic, emergency, or acute geriatric services) to capture patients immediately after a fragility fracture. However, this pilot study examined the potential benefits of a primary care-based FLS model, in which the identification, assessment and management of people at risk of secondary fractures are coordinated directly through general practitioners (GPs) rather than primarily within the hospital setting.
This pilot project, known as “The Primary Care Fracture Liaison Services (PCFLS)” was conducted in eastern Australia with the aim of improving the identification and management of people at risk of, or with, a previous fragility fracture.
Over an 18-month period, from June 2022 to December 2023, 1,299 individuals and 66 GPs across 51 general practices participated in the study.
Three registered nurses were appointed as Fracture Liaison Coordinators (FLC) to support participating GPs and practice staff in identifying at-risk individuals, performing bone health assessments, and providing patient education. On top of that, the FLCs were responsible for generating individualised patient management plans aligned with current clinical guidelines using the Compass IT platform (https://www.compasshealthplus.com/). The plans were then clinically reviewed by the GP and discussed with the patient, allowing patients to contribute to decisions about their care.
The results of the pilot study showed that FLCs working with community-based general practices, supported by an integrated IT platform, identified 316 new patients with osteoporosis who were eligible for subsidised treatment under the Australian Pharmaceutical Benefits Scheme (PBS). Of these patients, 141 commenced osteoporosis treatment, representing a treatment initiation rate of 45% (n = 141/316).
Importantly, these findings suggest that a primary care-based FLS may help identify patients with previously unrecognised osteoporosis and facilitate the initiation of appropriate treatment. This is particularly relevant given that osteoporosis remains frequently underdiagnosed and undertreated in primary care.
Lead author Professor Greg Lyubomirsky, CEO of Healthy Bones Australia, noted:
“Our experience suggests that this model can work in the real-world primary care setting, and the next step is to explore how it can be scaled to reach more patients and complement existing hospital-based fracture liaison services.”
The study concluded that a general practice-based FLS supported by a disease-specific IT platform improved osteoporosis diagnosis and management and was acceptable to both GPs and patients. In post-intervention evaluation surveys, 89% of participating GPs and 92% of patient respondents found the FLS service valuable and acceptable.
Ultimately, wider implementation of primary care-based FLS could complement existing hospital-based FLSs, extending fracture prevention into the community and potentially improving the identification and management of osteoporosis among patients who may otherwise be missed by hospital-based pathways.
References:
Lyubomirsky, G, et al. Implementation of a primary care-based fracture liaison service with information technology support to improve osteoporosis management in general practice–a pilot study. Bone (2026). https://www.sciencedirect.com/science/article/abs/pii/S8756328226001869
Compass is a comprehensive web-based chronic disease management platform developed in partnership with the Garvan Institute of Medical Research, Darlinghurst, NSW. It includes an Osteoporosis Platform owned by Healthy Bones Australia, a national not-for-profit, consumer-focused organisation working to improve bone health across Australia https://www.compasshealthplus.com/
Schedule of Pharmaceutical Benefits, Pharmaceutical Benefits Scheme, Australian Government Department of Health, Disability and Ageing, May 2026. Available from https://www.pbs.gov.au/browse/publications