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The importance of communication in secondary fragility fracture treatment and prevention

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Abstract

Introduction

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

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

This research was supported by a grant from the Alberta Heritage Foundation for Medical Research, Health Research Fund. Support was also provided through the Shopper’s Drug Mart Professorship in Women’s Health held by Meadows. The authors acknowledge and very much appreciate the assistance of our research associate Laura Lagendyk, and the editorial assistance of Kathy Dirk. We thank the journal reviewers for their detailed critique which enhanced the final manuscript.

Funding

The authors have no commercial or other associations that might pose a conflict of interest in connection with submitted material.

Author information

Authors and Affiliations

  1. Departments of Family Medicine and Community Health Sciences, University of Calgary, HM 06 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada

    L. M. Meadows

  2. Department of Surgery and Community Health Sciences, Division of Orthopaedic Surgery, Calgary Health Region, Calgary, Canada

    L. A. Mrkonjic

  3. Department of Surgery, Division of Orthopaedic Surgery, Calgary Health Region, Calgary, Canada

    M. D. O’Brien

  4. Department of Family Medicine, Calgary Health Region and University of Calgary, Calgary, Canada

    W. Tink

Authors
  1. L. M. Meadows
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  2. L. A. Mrkonjic
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  3. M. D. O’Brien
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  4. W. Tink
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Corresponding author

Correspondence to L. M. Meadows.

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Meadows, L.M., Mrkonjic, L.A., O’Brien, M.D. et al. The importance of communication in secondary fragility fracture treatment and prevention. Osteoporos Int 18, 159–166 (2007). https://doi.org/10.1007/s00198-006-0213-z

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  • DOI: https://doi.org/10.1007/s00198-006-0213-z

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