Osteoporosis International

, Volume 22, Issue 7, pp 2051–2065

Coordinator-based systems for secondary prevention in fragility fracture patients

Authors

  • D. Marsh
    • Institute of Orthopaedics and Musculoskeletal ScienceUniversity College London, Royal National Orthopaedic Hospital
    • Department of OrthopedicsSkåne University Hospital Malmö
  • D. E. Beaton
    • Mobility Program Clinical Research UnitLi Ka Shing Knowledge Institute, St. Michael’s Hospital
    • Department of Health Policy, Management and EvaluationUniversity of Toronto
  • E. R. Bogoch
    • Mobility Program Clinical Research UnitLi Ka Shing Knowledge Institute, St. Michael’s Hospital
    • Department of Surgery, St. Michael’s HospitalUniversity of Toronto
  • S. Boonen
    • Division of Gerontology and Geriatrics and Center for Musculoskeletal Research, Department of Experimental MedicineLeuven University
  • M.-L. Brandi
    • Department of Internal MedicineUniversity of Florence
  • A. R. McLellan
    • Western Infirmary and University of Glasgow
  • P. J. Mitchell
    • School of Health, Faculty of Education, Health and SciencesUniversity of Derby
  • J. E. M. Sale
    • Mobility Program Clinical Research UnitLi Ka Shing Knowledge Institute, St. Michael’s Hospital
    • Department of Health Policy, Management and EvaluationUniversity of Toronto
  • D. A. Wahl
    • International Osteoporosis Foundation
  • IOF CSA Fracture Working Group
Position Paper

DOI: 10.1007/s00198-011-1642-x

Cite this article as:
Marsh, D., Åkesson, K., Beaton, D.E. et al. Osteoporos Int (2011) 22: 2051. doi:10.1007/s00198-011-1642-x

Abstract

The underlying causes of incident fractures—bone fragility and the tendency to fall—remain under-diagnosed and under-treated. This care gap in secondary prevention must be addressed to minimise both the debilitating consequences of subsequent fractures for patients and the associated economic burden to healthcare systems. Clinical systems aimed at ensuring appropriate management of patients following fracture have been developed around the world. A systematic review of the literature showed that 65% of systems reported include a dedicated coordinator who acts as the link between the orthopaedic team, the osteoporosis and falls services, the patient and the primary care physician. Coordinator-based systems facilitate bone mineral density testing, osteoporosis education and care in patients following a fragility fracture and have been shown to be cost-saving. Other success factors included a fracture registry and a database to monitor the care provided to the fracture patient. Implementation of such a system requires an audit of existing arrangements, creation of a network of healthcare professionals with clearly defined roles and the identification of a ‘medical champion’ to lead the project. A business case is needed to acquire the necessary funding. Incremental, achievable targets should be identified. Clinical pathways should be supported by evidence-based recommendations from national or regional guidelines. Endorsement of the proposed model within national healthcare policies and advocacy programmes can achieve alignment of the objectives of policy makers, professionals and patients. Successful transformation of care relies upon consensus amongst all participants in the multi-disciplinary team that cares for fragility fracture patients.

Keywords

Clinical systemsFLSFracture preventionIOFOsteoporosisOsteoporotic fracture

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011