The fracture liaison service (FLS) is advocated as the most appropriate approach for secondary fracture prevention, but its implementation is variable between hospitals and countries. The International Osteoporosis Foundation (IOF) has proposed standards to evaluate the implementation of FLS. We did send an anonymous questionnaire based on the IOF FLS standards to 90 non-university hospitals in the Netherlands, of which 24 (27%) fully responded and results were assessed. In the 24 hospitals, 24,468 consecutive patients of 50 years and older with a recent fracture, representing around 25% of all fractures in the year 2012 in the Netherlands, were identified. After excluding patients with skull or toe fractures and upper age limits variable for each FLS, 11.983 (49%, range: 19%-95%) were able and willing to be examined. High implementation of IOF standards (>90%) was achieved for fracture patient identification, invitation for FLS, timing of assessment, identification of vertebral fractures, application of national guidelines, evaluation of secondary osteoporosis, drug initiation when indicated, communication with the general practitioner, and application of a follow up strategy. Noteworthy, some standards are highly variable (evaluation of secondary osteoporosis), difficult to apply (for vertebral fractures and fall prevention) or not attainable (for achieving a patient response rate above 90%). We conclude that all patients attending the FLS were evaluated, treated and followed with high implementation of IOF standards. The major shortcoming of the study outcome is the low response rate of invited patients to attend the FLS. Reasons for this low response rate and how to increase it, need further study. Some standards were difficult to apply and analyse, and therefore could need adaptation.
Disclosure: The authors declared no competing interests.