New national data from the Irish Fracture Liaison Service has exposed significant shortcomings in Ireland’s ability to prevent and manage fragility fractures – injuries that signal underlying bone weakness and dramatically increase the risk of further, often life-changing fractures.

The fourth Irish Fracture Liaison Service Database (FLS-DB) Report highlights both encouraging improvements in the quality of care for those who can access services and serious inequities in early identification, treatment and access nationwide.

Fragility fractures cost the HSE an estimated €464 million annually, and with Ireland’s ageing population, this figure is set to rise sharply without decisive action

Professor Frances Dockery, co-chair of the national Fracture Liaison Service Database, said: “A fracture, even if minor, is an important opportunity to examine bone health and so prevent major fractures ahead such as hip and spine, maintain independence and reduce unnecessary hospital admissions.

“Ireland has adopted a proven model of care that can do this, through Fracture Liaison Services, but we need to make it available to everyone and avoid missed opportunities to prevent future fractures.”

Significant regional inequities

The report analysed the experiences of 3,335 patients who sustained low-trauma ‘fragility’ fractures in 2024 across ten of Ireland’s sixteen adult trauma hospitals. It found that two HSE regions, the Midwest and South-West, managed no patients through a Fracture Liaison Service, while coverage in other regions varied from 12% in HSE Dublin and South-East to around 25% in Dublin and Midlands and HSE North/North-West. Nationally, 84% of non-hip fragility fractures still do not receive gold-standard preventative care.

This inconsistency means that access to fracture prevention remains a postcode lottery, with large parts of the country lacking any structured fracture liaison service.

A proven model

Fragility fractures are often the first warning sign of osteoporosis, doubling the risk of subsequent hip fractures. The consequences for patients can be severe, including loss of independence and reduced quality of life.

At a time when the Minister for Health has set a €633 million savings target across the health service for 2025, this approach represents a clinically proven, cost-effective solution to reduce avoidable admissions and free up hospital capacity

International experience shows what is possible. New Zealand’s national FLS strategy, backed by targeted investment, now captures more than 70% of patients presenting with fragility fractures and has saved an estimated 57,000 hospital bed days over five years.

Mr Tom McCarthy, Joint Clinical Lead, National Clinical Programme for Trauma and Orthopaedic Surgery, said: “Ireland has an opportunity to achieve similar impact by expanding and standardising its services. We must expand FLS coverage across all regions and address regional disparities to guarantee equitable access.”

The National Clinical Programme in Trauma and Orthopaedic Surgery is a strategic initiative between RCSI and the HSE. The programme aims to design and implement change initiatives to improve and standardise the quality of care and access for all patients in a cost-effective manner.

The programme established the national Fracture Liaison Service in 2018 with the goal of reducing the number of preventable fractures in the country.

Read the fourth Irish Fracture Liaison Service Database (FLS-DB) Report here.