Osteoporosis Refracture Prevention Model of Care


To ensure people who sustain a minimal trauma fracture have access to early identification, diagnosis, treatment, and follow-up for osteoporosis.


Benefits include improved patient outcomes, better utilisation of hospital services, and reductions in health system costs for at risk people.


The model of care for osteoporotic refracture prevention is based on an extensive body of evidence1; and has been informed by consultation with consumers, clinicians and managers. 

The essential element of the model of care is the engagement of a Fracture Liaison Coordinator (FLC). Their role is to ‘find’ the people who sustain a minimal trauma fracture, help them understand what is probably the underlying cause of sustaining a fracture from a mere ‘slip, trip or fall’, and link them to investigations and treatment. 

The FLC will also follow up these people in the long term, to review and support their sustained treatment and management. In addition, the FLC will ensure community education of osteoporosis is provided, and support other health professionals in gaining more understanding of this chronic disease. 

1.Ganda, K., Puech, M., Chen, J.S., Speerin, R., Bleasel, J., Center, J., Eisman, J.A., March, L., & Seibel, M.J, (2013). Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporosis International, 4, 2, 393-406. 



  • Murrumbidgee Medicare Local
  • North Coast NSW Medicare Local
  • Northern Sydney Medicare Local
  • South Eastern Sydney Medicare Local
  • Sydney North Shore & Beaches Medicare Local
  • CEC
  • Arthritis NSW
  • Osteoporosis Australia

Key Dates

Pilot Sites

Implementation Sites

Hunter New England Local Health DistrictCessnock District Hospital
The Maitland Hospital
John Hunter Hospital

Royal Newcastle Centre

Mid North Coast Local Health DistrictCoffs Harbour Base Hospital
Murrumbidgee Local Health DistrictWagga Wagga Base Hospital

Murrumbidgee Medicare Local

Nepean Blue Mountains Local Health DistrictNepean Hospital
Northern NSW Local Health DistrictGrafton Base Hospital
Lismore Base Hospital
The Tweed Hospital
Northern Sydney Local Health DistrictHornsby Ku-ring-gai Hospital
Manly Hospital
Mona Vale Hospital
Royal North Shore Hospital
South Eastern Sydney Local Health DistrictSouth Eastern Sydney Local Health District

South Eastern Sydney Medicare Local with St George Hospital

Sydney Local Health DistrictConcord Repatriation General Hospital
Royal Prince Alfred Hospital


In early 2015 the Musculoskeletal Network and the ACI Health Economics and Evaluation Team is reviewing the effect the model of care implementation is having on fracture prevention and hospital utilisation data. Plans are also in place to commence Summative Evaluation in late 2015.

Related Initiatives

Further Details

For more information go to:


The following resources can be accessed directly through the ACI website at: http://www.aci.health.nsw.gov.au/resources/clinician-resources#musculoskeletal

  • Osteoporosis Refracture Prevention Services Directory
  • DXA and QCT Densitometry


Robyn Speerin
ACI Musculoskeletal Network Manager
02 9464 4633

Chris Shipway
Director, Primary Care and Chronic Services
02 9464 4603

Page Top | Added: 7 November 2013 | Last modified: 9 February 2015