Original Article

Osteoporosis International

, Volume 18, Issue 2, pp 159-166

First online:

The importance of communication in secondary fragility fracture treatment and prevention

  • L. M. MeadowsAffiliated withDepartments of Family Medicine and Community Health Sciences, University of Calgary Email author 
  • , L. A. MrkonjicAffiliated withDepartment of Surgery and Community Health Sciences, Division of Orthopaedic Surgery, Calgary Health Region
  • , M. D. O’BrienAffiliated withDepartment of Surgery, Division of Orthopaedic Surgery, Calgary Health Region
  • , W. TinkAffiliated withDepartment of Family Medicine, Calgary Health Region and University of Calgary

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We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians.


Women and their treating physicians were followed for an average of one year post fracture to investigate the health outcomes and what, if any, follow-up occurred aimed at secondary fracture prevention. The final dataset includes 223 interviews gathered from women aged 40 to 65 with fragility fractures, orthopaedic surgeons and family physicians.


The circle of care for those with fragility fractures is disrupted at vital communication junctures: (1) the inconsistent flow of information between acute care institutions and family physicians; (2) unidirectional and inconsistent communication from orthopaedic surgeons to family physicians; and (3) competing demands of the cast clinic environment and patient expectations. It is not the lack of will that is undermining the consistent and detailed communication among patients, physicians and institutions. It is the episodic nature of fracture care that makes communication among involved parties difficult, if not impossible.


Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.


Communication Continuity of care Early intervention Osteoporosis Secondary fragility fractures Women’s health