For persons above fifty years of age, a history of fracture doubles the risk of a subsequent fracture
. This risk is highest immediately after the fracture, with a 5- to 25-fold increase of subsequent fracture risk within the first months and years
[1–6]. In patients with a recent fracture, other bone-related clinical risk factors, low bone mineral density (BMD) and fall-related risk factors are often present
. These risk factors are independently related to fracture risk and are used in algorithms to calculate fracture risk, like FRAX®
 and Garvan Fracture Risk calculator
. In addition, fall-related risk factors predict not only the risk of subsequent falls, but also of fractures. Therefore, these risk factors are sometimes integrated in fracture prediction algorithms
Fracture risk reduction has only been shown with specific anti-osteoporosis medication such as bisphosphonates, denosumab, raloxifene and recombinant PTH
[4, 10–17]. Fall prevention strategies decrease the risk of falls, however in these studies prevention of fractures was not demonstrated
In the field of post fracture care, a Fracture Liaison Service is one of the initiatives to integrate evaluation of bone- and fall-related risk factors in patients attending the hospital with a recent clinical fracture
The aim of the Fracture Liaison Service is to evaluate bone- and fall-related risk factors, to initiate fall prevention programs, adequate calcium and vitamin D supplementation and specific anti-osteoporosis medication when needed in order to reduce subsequent falls, fractures and mortality
[4, 6, 11, 19–21].
In this study, patients with a recent clinical fracture were assessed at the FLS at Maastricht University Medical Center for bone- and fall related risk factors and we hypothesised that over a 2-year follow-up period the subsequent fracture risk and mortality would be highest in patients with a combination of bone- and fall-related risk factors, even though these patients received anti-osteoporosis treatment and/or fall prevention.