OBJECTIVES: Fracture Liaison Services (FLSs) aim to improve fragility fracture (FF) care for secondary prevention status. A systematic follow-up (FU) of FLS patients could help reduce the refracture rate. This study aims to identify groups of patients with similar FU compliance patterns over a systematic FU in a high-intensity FLS, and the factors influencing these FU trajectory patterns. METHODS: Clinical data from a FLS with a 2-year systematic FU were merged to health administrative data. Participants (women and men aged >40 years with an incident FF) were recruited in an outpatient orthopedic setting, investigated for bone fragility and started on treatment when appropriate. Group-based trajectory modelling (GBTM) was used to identify trajectory groups of FU compliance over time. Patients were assigned to a trajectory group according to their posterior probability of group-membership. Predictors of trajectory groups were identified using multinomial logistic regressions. RESULTS: Of 532 participants, almost 86% were women and mean age was 63±11 years. Three trajectory groups of FU visit compliance were identified from GBTM: 1) 48.9% were high followers, 20.7% were intermediate followers, 30.4% were low followers. A lower femoral bone mineral density (OR=2.24, 95%CI 1.04-4.82), previous exposure to osteoporosis therapy (OR=1.76, 95%CI 1.02-3.04) and polypharmacy (OR=2.00, 95%CI 1.32-3.04) were predictors of being in the high followers’ compared to the low followers’ group; and those for being in the intermediate followers’ group were polypharmacy (OR=1.89, 95%CI 1.14-3.14) and referral to a bone specialist at baseline (OR=2.51, 95%CI 1.45-4.33). CONCLUSIONS: Results show that despite a high-intensity intervention, half the FLS patients will have an intermediate or low FU compliance pattern. This is important in the context of secondary prevention where subsequent FF risk is increased. Investigating the behavioural patterns of FU compliance with patient-centered research may help understand this phenomenon.