The overlooked burden of nonattendance in hip fracture liaison models of care.

Fragility fractures are among the most serious complications of osteoporosis, associated with high morbidity, mortality, and long-term disability. Fracture liaison service (FLS) programs have demonstrated effectiveness in improving osteoporosis evaluation and reducing refracture and mortality rates. However, patient nonattendance remains a critical and underappreciated barrier to program success. At our institution, a hip FLS initiative showed a nonattendance rate of 68%, with only 7 patients initiating antiresorptive therapy. We review the multifactorial causes of nonattendance and propose targeted strategies to overcome these barriers, aiming to achieve effective secondary fracture prevention for all high-risk patients.