Summary
The Renewed Women’s Health Strategy for England, 2026 stated:
Action 41: we will roll out fracture liaison services (FLS) across every part of the country by 2030. FLSs systematically identify people aged 50 and older who have had a ‘fragility fracture’ and are evidenced to reduce their risk of further fractures (including hip fractures).
When commissioning new fracture prevention services, in line with the 2030 objective, we expect ICBs to prioritise community-based models which align with the three shifts in the 10 Year Health Plan. This will aim to reduce the occurrence of secondary fractures and improve patients’ independence and quality of life.
New community-based services should be local and easy to access to patients, for example through use of community diagnostic centres, neighbourhood health centres and women's health hubs.
Services should be integrated with local services, for example rehabilitation and falls and fragility services.
All community based models should be built on evidence-based practice and recognised clinical guidelines and measured against established key performance indicators 43 across the patient pathway set out in the FLS Database.
A practical outline for FLS teams
Purpose
A community-based fracture prevention service brings coordinated osteoporosis and fracture-risk care closer to where people live. It can complement established hospital-based Fracture Liaison Services (FLS), supporting earlier identification, timely assessment, treatment and long-term follow-up, while retaining access to specialist expertise when needed.
Key principle: Community provision should strengthen, not replace, effective hospital-based FLS pathways.
Strategic alignment: the 10 Year Health Plan
A community-based fracture prevention service translates the Plan’s three NHS shifts into a practical bone-health pathway.
NHS shift | How the service model responds |
Hospital to community | Delivers assessment, monitoring, treatment support and follow-up closer to home, linked to primary care, neighbourhood teams, falls services and rehabilitation. Hospital-based FLS and specialist services remain essential for complex care and escalation. |
Treatment to prevention | Uses proactive case-finding, fracture-risk assessment, falls prevention and early osteoporosis management to prevent first and subsequent fragility fractures, rather than responding only after a fracture occurs. |
Analogue to digital | Connects primary, community and secondary-care records; supports data-led identification and follow-up; and uses FLS Database data to identify gaps, monitor equity and improve outcomes. Digital routes should sit alongside telephone and face-to-face access so they don't widen inequalities. |
This model extends fracture prevention into neighbourhood settings, makes long-term prevention and treatment adherence central to the pathway, and gives ICBs a framework for commissioning accessible, equitable services around local population need.
What could the service provide?
An end-to-end pathway for people at risk of fragility fracture, including those identified through primary care, falls services, community teams, previous fracture records and proactive case-finding.
Pathway element | What this could include |
Identify and refer | Proactive case-finding and clear routes from primary care, community services, falls teams and acute settings. |
Assess | Fracture-risk assessment, bone-health review, falls assessment, blood tests and timely access to DXA. |
Personalise management | Shared decision-making on lifestyle, falls prevention, calcium and vitamin D where appropriate, and osteoporosis medicines. |
Initiate and monitor treatment | Prescribing support, adherence and side-effect management, ongoing review, and clear escalation to specialist care. |
Follow up | Recall and monitoring that reduce treatment gaps and support long-term fracture prevention. |
Connect wider support | Links with rehabilitation, exercise, nutrition, smoking cessation, social prescribing and patient-support services. |
How should it work?
Local models should reflect population need and existing provision. They need clear responsibilities across primary, community and secondary care, with appropriate resources, clinical oversight and diagnostic capacity.
Align with standards - NICE guidance, the 5IQ approach and FLS Database reporting.
Use multidisciplinary expertise - strong clinical leadership, governance and access to specialist advice.
Connect digitally - relevant records available across settings, with data used to identify gaps and improve care.
Be accessible and equitable - digital, telephone and face-to-face options that work for women and men and don't widen inequalities.
Put people at the centre - involve patients in service design, shared decisions and evaluation.
Measure impact - track activity, treatment, adherence, equity and outcomes.
Practical enablers
Before implementation, assess workforce capacity and supervision, DXA and phlebotomy access, information governance, record interoperability and the impact of improved case-finding on diagnostic and treatment demand.
Integrated Care Boards can support local adoption by setting expectations, using local fracture and FLS data to identify need, sharing effective models, and commissioning pathways that link community provision with established FLS and specialist services.
Community based fracture prevention model in action
West Suffolk community-based FLS is delivering fracture prevention at scale, in line with the shift in the 10 Year Health Plan from hospital to community.
The model is nurse-led, remote-first and digitally enabled. Monthly fracture data are digitally triaged to identify fragility fractures.
Assessments are primarily delivered by phone, with home allowing the service to reach frail, elderly and housebound patients.
The service works closely with general practice, DEXA (bone density) scanning, orthogeriatrics, radiology, rheumatology and community teams. Since 2022 it has delivered denosumab (injectable treatment for osteoporosis) for around 700 patients who would otherwise have been referred to secondary care to receive this treatment.
In summary
A community-based fracture prevention service model is a coordinated, data-informed approach to helping people receive the right bone-health support in the right setting. Its value is in extending the reach of fracture prevention, improving continuity of care and reducing avoidable fractures - while maintaining strong connections with hospital-based FLS and specialist services.
This community based fracture prevention service model was produced in collaboration with FLS clinical experts and people living with osteoporosis.
