Abstract
Purpose of Review
This review sought to describe quality improvement initiatives in fragility fracture care and prevention.
Recent Findings
A major care gap persists throughout the world in the secondary prevention of fragility fractures. Systematic reviews have confirmed that the Fracture Liaison Service (FLS) model of care is associated with significant improvements in rates of bone mineral density testing, initiation of osteoporosis treatment and adherence with treatment for individuals who sustain fragility fractures. Further, these improvements in the processes of care resulted in significant reductions in refracture risk and lower post-fracture mortality. The primary challenge facing health systems now is to ensure that best practice is delivered effectively in the local healthcare setting. Publication of clinical standards for FLS at the organisational and patient level in combination with the establishment of national registries has provided a mechanism for FLS to benchmark and improve their performance.
Summary
Major efforts are ongoing at the global, regional and national level to improve the acute care, rehabilitation and secondary prevention for individuals who sustain fragility fractures. Active participation in these initiatives has the potential to eliminate current care gaps in the coming decade.
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Funding
Amgen Asia provided financial support to fund a secretariat function, event management and communication activities leading up to the formation of the Asia Pacific Fragility Fracture Alliance (APFFA), noting Amgen Asia had no role in the development of this publication.
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Conflict of Interest
Paul Mitchell (PM): PM has undertaken consultancy for governments, national and international osteoporosis societies, healthcare professional organisations and private sector companies relating to systematic approaches to fragility fracture care and prevention since 2005.
Cyrus Cooper (CC): CC has received consulting fees and honoraria from Amgen, Danone, Eli Lilly, GSK, Medtronic, Merck, Nestle, Novartis, Pfizer, Roche, Servier, Shire, Takeda and UCB.
Masaki Fujita (MF): MF has no disclosures relating to this work. MF is the Project Leader of the Capture the Fracture® Programme of the International Osteoporosis Foundation.
Philippe Halbout (PH): PH has no disclosures relating to this work. PH is the Chief Executive Officer of the International Osteoporosis Foundation.
Kristina Åkesson (KA): KA has no disclosures relating to this work. KA has received consultancy fees from Amgen, Eli Lilly, Renapharma and UCB.
Matthew Costa (MC): MC has no disclosures relating to this work.
Karsten Dreinhöfer (KD): KD has undertaken consultancy for governments, national osteoporosis societies, healthcare professional organisations and private sector companies relating to systematic approaches to fragility fracture care and prevention since 2004.
David Marsh (DM): DM has no disclosures relating to this work.
Joon-Kiong Lee (JKL): JKL has no disclosures relating to this work.
Ding-Cheng (Derrick) Chan (DCC): DCC has no disclosures relating to this work. DCC is a consultant for Amgen.
M. Kassim Javaid (MKJ): In the last 5 years, MKJ received honoraria, unrestricted research grants, travel and/or subsistence expenses from Amgen, Lilly UK, Internis, Consilient Health, Zebra Medical Vision, Kyowa Kirin Hakin and UCB.
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Mitchell, P.J., Cooper, C., Fujita, M. et al. Quality Improvement Initiatives in Fragility Fracture Care and Prevention. Curr Osteoporos Rep 17, 510–520 (2019). https://doi.org/10.1007/s11914-019-00544-8
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DOI: https://doi.org/10.1007/s11914-019-00544-8
Keywords
- Fracture Liaison Service
- Orthogeriatric Services
- Secondary fracture prevention
- Systems-based approach
- Fracture prevention policy
- Capture the Fracture®
- Osteoporosis
- Fragility fracture
- International Osteoporosis Foundation
- Fragility Fracture Network
- American Society for Bone and Mineral Research
- Asia Pacific Fragility Fracture Alliance