Fragility fractures are sentinels of osteoporosis, and as such all patients with low-trauma fractures should be considered for further investigation for osteoporosis and, if confirmed, started on osteoporosis medication. Fracture liaison services (FLSs) with varying models of care are in place to take responsibility for this investigative and treatment process. This review aims to describe outcomes for patients with osteoporotic fragility fractures as part of FLSs. The most intensive service that includes identification, assessment and treatment of patients appears to deliver the best outcomes. This FLS model is associated with reduction in re-fracture risk (hazard ratio [HR] 0.18–0.67 over 2–4 years), reduced mortality (HR 0.65 over 2 years), increased assessment of bone mineral density (relative risk [RR] 2–3), increased treatment initiation (RR 1.5–4.25) and adherence to treatment (65%–88% at 1 year) and is cost-effective. In response to this evidence, key organizations and stakeholders have published guidance and framework to ensure that best practice in FLSs is delivered.

In the first study, frailty was identified in 70.8% of vertebral fracture patients using PRISMA-7 tool; 66.7% with the GFI; and 33.3% with the EFS. A further 20.8% were considered vulnerable to frailty on the EFS. Almost 30% were considered frail on all the three scales. Three quarters had a timed-up-and-go of >20seconds. Median Barthel Index was 18 (range 6-20); and the median abbreviated mental test was 9 (range 2-10), which suggests a cohort that is mostly independent with personal activities of daily living with good levels of cognition. In the second study, compared to patients with hip fracture, patients with vertebral fractures were younger; more likely to be living independently; less likely to have fallen in the last year; were taking more medication; and had equal number of co-morbidities as patients with hip fractures Conclusion: Frailty is prevalent in those admitted to hospital with a vertebral fragility fracture. Treatment of their acute fracture will need to include addressing their frailty issues.

In our study, instrumental deliveries, the use of internal manoeuvres (Woods' screw and reverse Woods' screw) and four or more manoeuvres for the management of SD were independently associated with a higher incidence of OASIS. To effectively manage shoulder dystocia with lower risks of perineal trauma, these factors could be considered when designing further prospective studies and developing management protocols.

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