What is a Fracture Liaison Service?

A Fracture Liaison Service (FLS) fracture prevention program provides a bone evaluation and develops a personalized plan for you to reach and maintain your bone health to prevent future broken bones (also called fractures). If you are age 50 or older and have had a broken bone our FLS will be contacting you.

The FLS helps you reduce the risk of suffering from another broken bone. Your active participation and positive attitude will help you along this journey to better bone health.

Your Initial Visit

During your first visit we will review your medical history, the history of your recent fracture, evaluate your risk for another broken bone and discuss treatment options.

Your provider may ask:

Have you had a bone density test? If so, when was it done?

Have you ever been told that you had bone loss, weak bones, osteoporosis or osteopenia?

Do you take calcium or vitamin D supplements?

Have you had any other broken bones since you turned age 50?

You will be scheduled for a follow-up visit one to three months after your initial visit. At that time, your provider will help evaluate your treatment and continue planning your care.

Lab Work and Bone Screening

In order to understand your current bone health and determine why you had a broken bone, your healthcare provider will use a combination of the following methods:

Medical history

Your healthcare provider will ask you questions to get a complete medical history. In particular, you will be asked questions about any personal history of fracture, family history of fractures and other risk factors for osteoporosis. It is important to let your doctor know the medications you have been taking during the last 10 years because some are known to increase an individual’s risk for low bone mass and fractures.

Physical examination

Your doctor will give you a limited physical exam with emphasis on the spine or backbone. Many fractures in the spine go unnoticed by patients. Loss of height is often a sign of vertebral or spinal fractures.

Laboratory tests

There are some lab tests that are specific to bone health. We will check your medical records to see if any of these have been performed in the last six months. If so, we will not repeat these tests; and if not, we will need to perform the lab work.


An x-ray can help your provider determine if you have had any fragility fractures of the spine.

Bone density scan

If the above tests indicate probable loss of bone density, we will make arrangements for you to have a bone density scan if one has not been done in the last year. This will help your doctor confirm a diagnosis of osteoporosis and document the severity of bone loss.

With most types of bone density tests, a person remains fully dressed. The test usually takes less than 15 minutes. Bone density tests are non-invasive and painless. This means no needles or instruments are placed through the skin or body. A central DXA uses very little radiation. You are actually exposed to 10-15 times more radiation when you fly roundtrip between New York and San Francisco.

Patient Financial Service Guidelines

We understand your concerns about the costs of your healthcare. Insurance claims, along with doctor and hospital bills, can be confusing.

Hospital and Doctor Bills

Fracture Liaison Service’s are considered a medical necessity by most insurance providers, because of the risk of fractures. Your insurance will likely cover these expenses. Please contact your insurance provider to find out which services are covered.

Health Insurance

If you do receive a bill, be sure to forward it your insurance provider to have them pay their portion first. Some insurance providers cover 100 percent for these preventative services.

Patient responsibility

Deductibles, co-insurance, co-pays and other balances are due when you receive your services.


Broken bones in people age 50 or older are very often caused by osteoporosis. If you’ve just had a fracture or have just been diagnosed with osteoporosis, you probably have a lot of questions. We realize the diagnosis can be worrisome and even overwhelming, but we’re here to help.

Here are some Web sites that can provide high-quality health information to help you get started learning more about osteoporosis and the steps you can take to protect your bones.

National Osteoporosis Foundation www.nof.org

National Bone Health Alliance www.nbha.org

Fracture Prevention CENTRAL (NBHA resource center on FLS programs)www.fracturepreventioncentral.org

Meet the LIMA Fracture Liaison Team


Dr. Francis Gallagher

Dr. Thomas Kantor

Dr. Ernesto Gutierrez

Dr. David Trostle

Bone Density Testing:

Debra Dipasquale

Lisa Steiner

Physical Therapy:

Leanne Hains

Jessica Deck

Karen Jiwa