The IOF Capture the Fracture® Working Group, with the National Osteoporosis Foundation and the Fragility Fracture Network, has developed 11 patient-level performance indicators to measure FLS effectiveness and guide quality improvement.

The International Osteoporosis Foundation (IOF) Capture the Fracture® Working Group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation has adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level Key Performance Indicator (KPI) set for Fracture Liaison Services (FLSs)1.

An FLS is a coordinated system of care that identifies, investigates, recommends treatment and monitors over time patients aged 50 and above presenting with a fragility fracture. FLS have demonstrated their potential clinical and cost effectiveness and have been recommended worldwide to reduce fracture risk after a first fracture. The IOF Capture the Fracture® Best Practice Framework (BPF)2 is a recognized guidance which is used to assess the organisational components of an FLS, and has been implemented in more than 400 FLS globally. The new publication presents a complementary KPI set that measures the real-world secondary fracture prevention delivery at the patient level.

Associate Professor Kassim Javaid, co-chair of the Capture the Fracture® Programme stated:

"The newly developed KPI set represents an important new tool for established FLS. It will help FLS examine their current performance and add service improvement cycles to their routine service provision, and it will permit further benchmarking against FLSs regionally, nationally and internationally.”

The eleven KPIs selected look at the proportion of patients with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started antiosteoporosis medication within 16 weeks of sentinel fracture; and prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set as < 50%, 50–80% and > 80% levels except for treatment recommendation where a level of 50% was used.

Professor Cyrus Cooper, president of IOF, added:

"A first fragility fracture is a strong predictor of secondary fractures, which are associated with morbidity, excess mortality, and enormous socioeconomic costs. Yet despite a wide range of effective anti-osteoporosis medications and the increase in the world’s aged populations, the proportion of patients receiving adequate secondary fracture prevention is alarmingly low.”

"IOF urges health care systems worldwide to implement FLSs, as they have been shown to be the most effective way to tackle the burden of secondary fractures. The newly developed patient-level performance indicators, which complement the Capture the Fracture® Best Fracture Framework, will help established FLSs reach their full potential in the context of local challenges and opportunities, leading to improved patient care and outcomes.”


1. Javaid, M.K., Sami, A., Lems, W. et al. A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network. Osteoporos Int (2020). 
2. Capture the Fracture® Best Practice Framework

About Capture the Fracture®
Capture the Fracture® (CTF) is a multi-stakeholder initiative led by the International Osteoporosis Foundation. The initiative hopes to drive changes at local and international levels, so that secondary fracture prevention becomes a reality. Its aim is to set global best practices for Fracture Liaison Services (FLS), while serving as a benchmark tool to which clinics and hospitals can adhere and aspire to, and receive international recognition. The CTF programme has a diverse set of tools that provides essential resources and documentation to drive quality improvement in FLS; CTF also offers mentorship programmes that support development of FLS at the local level. Currently the CTF network includes more than 400 FLS from 46 countries worldwide.  #CaptureTheFracture