Osteoporosis International

, Volume 22, Issue 7, pp 2051–2065 | Cite as

Coordinator-based systems for secondary prevention in fragility fracture patients

  • D. Marsh
  • K. ÅkessonEmail author
  • D. E. Beaton
  • E. R. Bogoch
  • S. Boonen
  • M.-L. Brandi
  • A. R. McLellan
  • P. J. Mitchell
  • J. E. M. Sale
  • D. A. Wahl
  • IOF CSA Fracture Working Group
Position Paper


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.


Clinical systems FLS Fracture prevention IOF Osteoporosis Osteoporotic fracture 



The Fracture Working Group of the IOF Committee of Scientific Advisors was supported by the International Osteoporosis Foundation. David Marsh, Earl R. Bogoch, Alastair McLellan and Paul J. Mitchell are also members of the ASBMR Working Group on Systems-Based Approaches to Secondary Fracture Prevention. Steven Boonen is a senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) and holder of the Leuven University Chair in Gerontology and Geriatrics.

Conflicts of interest

DM—advisory board for Amgen, Novartis, Servier, Medtronic and Striker Biotech but not in conflict with this manuscript. KA, DB, ERB, SB, MLB, ARM, JS and DAW declare no conflict of interest with this manuscript. PJM has participated in advisory boards and/or provided consultancy to Amgen, Daiichi Sankyo UK Ltd, GSK, MSD-Asia, Novartis, ProStrakan, Roche, Shire and Servier.


  1. 1.
    Kanis JA, Johnell O, Oden A, Sernbo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674PubMedCrossRefGoogle Scholar
  2. 2.
    Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6:99–105PubMedCrossRefGoogle Scholar
  3. 3.
    Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P (2004) Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int 15:87–94PubMedCrossRefGoogle Scholar
  4. 4.
    von Friesendorff M, Besjakov J, Åkesson K (2008) Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res 23:1832–1841CrossRefGoogle Scholar
  5. 5.
    von Friesendorff M, Besjakov J, Åkesson K (2006) Long-term survival, incident fractures and recurrent trauma after hip fracture. An 18 year follow-up study in 263 men. J Bone Miner Res 22:S200Google Scholar
  6. 6.
    Larsen ER, Mosekilde L, Foldspang A (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19:370–378PubMedCrossRefGoogle Scholar
  7. 7.
    Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809PubMedCrossRefGoogle Scholar
  8. 8.
    Mathoo J, Cranney A, Papaioannou A, Adachi J (2004) Rational use of oral bisphosphonates for the treatment of osteoporosis. Curr Osteoporos Rep 2:17–23PubMedCrossRefGoogle Scholar
  9. 9.
    Silverman SL, Watts NB, Delmas PD, Lange JL, Lindsay R (2007) Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: the risedronate and alendronate (REAL) cohort study. Osteoporos Int 18:25–34PubMedCrossRefGoogle Scholar
  10. 10.
    Stevenson M, Jones ML, De Nigris E, Brewer N, Davis S, Oakley J (2005) A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess 9:1–160PubMedGoogle Scholar
  11. 11.
    Amamra N, Berr C, Clavel-Chapelon F, Delcourt C, Delmas PD, Derriennic F, Ducimetière P, Goldberg M, Letenneur L, Rabilloud M, Meunier PJ, Schott AM (2004) Estimated number of women likely to benefit from bone mineral density measurement in France. Joint Bone Spine 71:409–418PubMedCrossRefGoogle Scholar
  12. 12.
    Brankin E, Mitchell C, Munro R (2005) Closing the osteoporosis management gap in primary care: a secondary prevention of fracture programme. Curr Med Res Opin 21:475–482PubMedCrossRefGoogle Scholar
  13. 13.
    Eisman J, Clapham S, Kehoe L (2004) Osteoporosis prevalence and levels of treatment in primary care: the Australian BoneCare study. J Bone Miner Res 19:1969–1975PubMedCrossRefGoogle Scholar
  14. 14.
    Edwards BJ, Bunta AD, Simonelli C, Bolander M, Fitzpatrick LA (2007) Prior fractures are common in patients with subsequent hip fractures. Clin Orthop 461:226–230PubMedGoogle Scholar
  15. 15.
    Gallagher JC, Melton LJ, Riggs BL, Bergstrath E (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop 150:163–171PubMedGoogle Scholar
  16. 16.
    McLellan AR, Reid DM, Forbes K, Reid R, Campbell C, Gregori A, Raby N, Simpson A (2004) Effectiveness of strategies for the secondary prevention of osteoporotic fractures in Scotland. NHS Quality Improvement Scotland (project CEPS 99/03) http://wwwnhshealthqualityorg/nhsqis/files/99_03FullReportFINAL_040705pdf. Accessed 25 Oct 2010
  17. 17.
    Port L, Center J, Briffa NK, Nguyen T, Cumming R, Eisman J (2003) Osteoporotic fracture: missed opportunity for intervention. Osteoporos Int 14:780–784PubMedCrossRefGoogle Scholar
  18. 18.
    Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778PubMedCrossRefGoogle Scholar
  19. 19.
    Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305PubMedCrossRefGoogle Scholar
  20. 20.
    Sale JEM, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int doi: 10.1007/s00198-011-1544-y
  21. 21.
    Majumdar SR, Beaupre LA, Harley CH, Hanley DA, Lier DA, Juby AG, Maksymowych WP, Cinats JG, Bell NR, Morrish DW (2007) Use of a case manager to improve osteoporosis treatment after hip fracture—results of a randomized controlled trial. Arch Intern Med 167:2110–2115PubMedCrossRefGoogle Scholar
  22. 22.
    Sidwell AI, Wilkinson TJ, Hanger HC (2004) Secondary prevention of fractures in older people: evaluation of a protocol for the investigation and treatment of osteoporosis. Intern Med J 34:129–132PubMedCrossRefGoogle Scholar
  23. 23.
    Gardner MJ, Flik KR, Mooar P, Lane JM (2002) Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am 84A:1342–1348Google Scholar
  24. 24.
    Prasad N, Sunderamoorthy D, Martin J, Murray JM (2006) Secondary prevention of fragility fractures: are we following the guidelines? Closing the audit loop. Ann R Coll Surg Engl 88:470–474PubMedCrossRefGoogle Scholar
  25. 25.
    Bliuc D, Eisman J, Center J (2006) A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporos Int 17:1309–1317PubMedCrossRefGoogle Scholar
  26. 26.
    Gallacher SJ (2005) Setting up an osteoporosis fracture liaison service: background and potential outcomes. Best Pract Res Clin Rheumatol 19:1081–1094PubMedCrossRefGoogle Scholar
  27. 27.
    Langridge CR, McQuillian C, Watson WS, Walker B, Mitchell L, Gallacher SJ (2007) Refracture following Fracture Liaison Service assessment illustrates the requirement for integrated falls and fracture services. Calcif Tissue Int 81:85–91PubMedCrossRefGoogle Scholar
  28. 28.
    McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14:1028–1034PubMedCrossRefGoogle Scholar
  29. 29.
    Murray AW, McQuillan C, Kennon B, Gallacher SJ (2005) Osteoporosis risk assessment and treatment intervention after hip or shoulder fracture—a comparison of two centres in the United Kingdom. Injury 36:1080–1084PubMedCrossRefGoogle Scholar
  30. 30.
    Kuo I, Ong C, Simmons L, Bliuc D, Eisman J, Center J (2007) Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteoporos Int 18:1633–1639PubMedCrossRefGoogle Scholar
  31. 31.
    Harrington JT, Lease J (2007) Osteoporosis disease management for fragility fracture patients: new understandings based on three years' experience with an osteoporosis care service. Arthritis Rheum 57:1502–1506PubMedCrossRefGoogle Scholar
  32. 32.
    Dell R, Greene D, Schelkun SR, Williams K (2008) Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Joint Surg Am 90:188–194PubMedCrossRefGoogle Scholar
  33. 33.
    Tosi LL, Gliklich R, Kannan K, Koval KJ (2008) The American Orthopaedic Association's "Own the Bone" initiative to prevent secondary fractures. J Bone Joint Surg Am 90:163–173PubMedCrossRefGoogle Scholar
  34. 34.
    Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymowych WP, Steiner IP, Harley CH et al (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373PubMedGoogle Scholar
  35. 35.
    Feldstein A, Elmer PJ, Smith DH, Herson M, Orwoll E, Chen CH, Aickin M, Swain MC (2006) Electronic medical record reminder improves osteoporosis management after a fracture: a randomized, controlled trial. J Am Geriatr Soc 54:450–457PubMedCrossRefGoogle Scholar
  36. 36.
    Jachna CM, Whittle J, Lukert B, Graves L, Bhargava T (2003) Effect of hospitalist consultation on treatment of osteoporosis in hip fracture patients. Osteoporos Int 14:665–671PubMedCrossRefGoogle Scholar
  37. 37.
    Quintos-Macasa AM, Quinet R, Spady M, Zakem J, Davis W, Menon Y, Serebro L, Krousel-Wood MA (2007) Implementation of a mandatory rheumatology osteoporosis consultation in patients with low-impact hip fracture. J Clin Rheumatol 13:70–72PubMedCrossRefGoogle Scholar
  38. 38.
    Schmid L, Henzen C, Schlumpf U, Babst R (2004) Improving secondary prevention in fragility fracture patients: the impact of a simple clinical information procedure. J Appl Res 4:570–575Google Scholar
  39. 39.
    Streeten EA, Mohamed A, Gandhi A, Orwig D, Sack P, Sterling R, Pellegrini VD Jr (2006) The inpatient consultation approach to osteoporosis treatment in patients with a fracture. Is automatic consultation needed? J Bone Joint Surg Am 88:1968–1974PubMedCrossRefGoogle Scholar
  40. 40.
    Ashe M, Khan K, Guy P, Hughes K, Kruse K, McKay H (2004) Wristwatch: distal radius fractures as a marker for osteoporosis investigation. J Hand Ther 17:80–81CrossRefGoogle Scholar
  41. 41.
    Bessette L, Ste-Marie L-G, Jean S, Shawn Davison K, Beaulieu M, Baranci M, Bessant J, Brown JP (2008) Recognizing osteoporosis and its consequences in Quebec (ROCQ): background, rationale, and methods of an anti-fracture patient health-management programme. Contemp Clin Trials 29:194–210PubMedCrossRefGoogle Scholar
  42. 42.
    Davis JC, Guy P, Ashe MC, Liu-Ambrose T, Khan K (2007) HipWatch: osteoporosis investigation and treatment after a hip fracture: a 6-month randomized controlled trial. J Gerontol A Biol Sci Med Sci 62:888–891PubMedGoogle Scholar
  43. 43.
    Hawker G, Ridout R, Ricupero M, Jaglal S, Bogoch E (2003) The impact of a simple fracture clinic intervention in improving the diagnosis and treatment of osteoporosis in fragility fracture patients. Osteoporos Int 14:171–178PubMedCrossRefGoogle Scholar
  44. 44.
    van Helden S, van Geel ACM, Geusens PP, Kessels A, Kruseman ACN, Brink PRG (2008) Bone and fall-related fracture risks in women and men with a recent clinical fracture. J Bone Joint Surg Am 90A:241–248CrossRefGoogle Scholar
  45. 45.
    Hegeman JH, Oskam J, Van der Palen J, Ten Duis HJ, Vierhout PAM (2004) The distal radial fracture in elderly women and the bone mineral density of the lumbar spine and hip. J Hand Surg Br 29B:473–476Google Scholar
  46. 46.
    Liel Y, Castel H, Bonneh DY (2003) Impact of subsidizing effective anti-osteoporosis drugs on compliance with management guidelines in patients following low-impact fractures. Osteoporos Int 14:490–495PubMedCrossRefGoogle Scholar
  47. 47.
    Skedros JG (2004) The orthopaedic surgeon's role in diagnosing and treating patients with osteoporotic fractures: standing discharge orders may be the solution for timely medical care. Osteoporos Int 15:405–410PubMedCrossRefGoogle Scholar
  48. 48.
    Blonk MC, Erdtsieck RJ, Wernekinck MGA, Schoon EJ (2007) The fracture and osteoporosis clinic: 1-year results and 3-month compliance. Bone 40:1643–1649PubMedCrossRefGoogle Scholar
  49. 49.
    Chevalley T, Hoffmeyer P, Bonjour JP, Rizzoli R (2002) An osteoporosis clinical pathway for the medical management of patients with low-trauma fracture. Osteoporos Int 13:450–455PubMedCrossRefGoogle Scholar
  50. 50.
    Cuddihy MT, Amadio PC, Gabriel SE, Pankratz VS, Kurland RL, Melton LJ (2004) A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture. Osteoporos Int 15:695–700PubMedCrossRefGoogle Scholar
  51. 51.
    Majumdar SR, Johnson JA, McAlister FA, Bellerose D, Russell AS, Hanley DA, Morrish DW, Maksymowych WP, Rowe BH (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. Can Med Assoc J 178:569–575CrossRefGoogle Scholar
  52. 52.
    Jaglal S, Hawker G, Bansod V, Salbach N, Zwarenstein M, Carroll J, Brooks D, Cameron C, Bogoch E, Jaakkimainen L, Kreder H (2009) A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada. Osteoporos Int 20:265–274PubMedCrossRefGoogle Scholar
  53. 53.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRefGoogle Scholar
  54. 54.
    Che M, Ettinger B, Liang J, Pressman AR, Johnston J (2006) Outcomes of a disease-management program for patients with recent osteoporotic fracture. Osteoporos Int 17:847–854PubMedCrossRefGoogle Scholar
  55. 55.
    Edwards BJ, Bunta AD, Madison LD, DeSantis A, Ramsey-Goldman R, Taft L, Wilson C, Moinfar M (2005) An osteoporosis and fracture intervention program increases the diagnosis and treatment for osteoporosis for patients with minimal trauma fracture. Jt Comm J Qual Patient Saf 31:267–274PubMedGoogle Scholar
  56. 56.
    Gardner MJ, Brophy RH, Demetrakopoulos D, Koob J, Hong R, Rana A, Lin JT, Lane JM (2005) Interventions to improve osteoporosis treatment following hip fracture—a prospective, randomized trial. J Bone Joint Surg Am 87A:3–7CrossRefGoogle Scholar
  57. 57.
    Dell R, Greene D, Schelkun SR, Williams K (2009) Osteoporosis disease management: what every orthopaedic surgeon should know. J Bone Joint Surg Am 91:79–86PubMedCrossRefGoogle Scholar
  58. 58.
    Astrand J, Thorngren KG, Tagil M (2006) One fracture is enough! Experience with a prospective and consecutive osteoporosis screening program with 239 fracture patients. Acta Orthop 77:3–8PubMedCrossRefGoogle Scholar
  59. 59.
    Becker C, Crow S, Toman J, Lipton C, McMahon D, Macaulay W, Siris E (2006) Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos Int 17:410–416PubMedCrossRefGoogle Scholar
  60. 60.
    van Helden S, Cauberg E, Geusens P, Winkes B, van der Weijden T, Brink P (2007) The fracture and osteoporosis outpatient clinic: an effective strategy for improving implementation of an osteoporosis guideline. J Eval Clin Pract 13:801–805PubMedCrossRefGoogle Scholar
  61. 61.
    Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88A:25–34CrossRefGoogle Scholar
  62. 62.
    Fraser M, McLellan AR (2004) A fracture liaison service for patients with osteoporotic fractures. Prof Nurse 19:286–290PubMedGoogle Scholar
  63. 63.
    Hegeman JH, Willemsen G, Van Nieuwpoort J, Kreeftenberg HG, Van der Veer E, Slaets JPJ, Ten Duis HJ (2005) Effective case-finding of osteoporosis in a fracture and osteoporosis clinic in Groningen: an analysis of the first 100 patients. Aktuelle Traumatol 35:34–39CrossRefGoogle Scholar
  64. 64.
    Levasseur R, Sabatier JP, Guilcher C, Guaydier-Souquieres G, Costentin-Pignol V, Jean-Jacques PY, Hulet C, Vielpeau C, Marcelli C (2007) Medical management of patients over 50 years admitted to orthopedic surgery for low-energy fracture. Joint Bone Spine 74:160–165PubMedCrossRefGoogle Scholar
  65. 65.
    Vaile J, Sullivan L, Bennett C, Bleasel J (2007) First Fracture Project: addressing the osteoporosis care gap. Intern Med J 37:717–720PubMedCrossRefGoogle Scholar
  66. 66.
    Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA (2004) Fracture incidence and association with bone mineral density in elderly men and women. The Rotterdam Study. Bone 34:195–202PubMedCrossRefGoogle Scholar
  67. 67.
    Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, Berger ML (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164:1108–1112PubMedCrossRefGoogle Scholar
  68. 68.
    Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. JAMA 286:2815–2822PubMedCrossRefGoogle Scholar
  69. 69.
    Kanis JA, Barton IP, Johnell O (2005) Risedronate decreases fracture risk in patients selected solely on the basis of prior vertebral fracture. Osteoporos Int 16:475–482PubMedCrossRefGoogle Scholar
  70. 70.
    Eastell R, Black DM, Boonen S, Adami S, Felsenberg D, Lippuner K, Cummings SR, Delmas PD, Palermo L, Mesenbrink P, Cauley JA, HORIZON Pivotal Fracture Trial (2009) Effect of once-yearly zoledronic acid 5 mg on fracture risk and change in femoral neck bone mineral density: subgroup analyses of the HORIZON-PFT study. J Clin Endocrinol Metab 94:3215–3225PubMedCrossRefGoogle Scholar
  71. 71.
    Kanis JA, McCloskey E, Jonsson B, Cooper A, Strom O, Borgstrom F (2010) An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women. Arch Osteoporos 5:19–48CrossRefGoogle Scholar
  72. 72.
    Jarvinen TLN, Sievanen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336:124–126PubMedCrossRefGoogle Scholar
  73. 73.
    Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N (2010) Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 1:CD005465PubMedGoogle Scholar
  74. 74.
    Chang JT, Morton SC, Rubenstein L, Mojica W, Maglione M, Suttorp M, Roth E, Shekelle P (2004) Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 328:680PubMedCrossRefGoogle Scholar
  75. 75.
    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2:CD007146PubMedGoogle Scholar
  76. 76.
    Tinetti ME, Kumar C (2010) The patient who falls: "it's always a trade-off". JAMA 303:258–266PubMedCrossRefGoogle Scholar
  77. 77.
    Berggren M, Stenvall M, Olofsson B, Gustafson Y (2008) Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up. Osteoporos Int 19:801–809PubMedCrossRefGoogle Scholar
  78. 78.
    Stenvall M, Olofsson B, Lundström M, Englund U, Borssén B, Svensson O, Nyberg L, Gustafson Y (2007) A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 18:167–175PubMedCrossRefGoogle Scholar
  79. 79.
    Kannus P, Sievänen H, Palvanen M, Järvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366:1885–1893PubMedCrossRefGoogle Scholar
  80. 80.
    Siris E, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022PubMedCrossRefGoogle Scholar
  81. 81.
    Majumdar SR, Lier DA, Beaupre LA, Hanley DA, Maksymowych WP, Juby AG, Bell NR, Morrish DW (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 169:25–31PubMedCrossRefGoogle Scholar
  82. 82.
    Sander B, Elliot-Gibson V, Beaton DE, Bogoch ER, Maetzel A (2008) A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. J Bone Joint Surg Am 90:1197–1205PubMedCrossRefGoogle Scholar
  83. 83.
    Majumdar SR, Lier DA, Rowe BH, Russell AS, McAlister FA, Maksymowych WP, Hanley DA, Morrish DW, Johnson JA (2011) Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture. Osteoporos Int doi: 10.1007/s00198-010-1412-1
  84. 84.
    McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int doi: 10.1007/s00198-011-1534-0 Google Scholar
  85. 85.
    Kanis JA, on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care level. Technical report. WHO Collaborating Centre, University of Sheffield, UKGoogle Scholar
  86. 86.
    The Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians (2006) National audit of the organisation of services for falls and bone health for older people. Accessed 28 Oct 2010
  87. 87.
    British Orthopaedic Association (2007) The care of patients with fragility fracture. Accessed 28 Oct 2010
  88. 88.
    Department of Health in England (2008) Prevention speech: old age is the new middle age, by the Rt Hon Alan Johnson MP, Secretary of State for Health, 21 May 2008. Accessed 28 Oct 2010
  89. 89.
    Department of Health in England (2009) Prevention package for older people. Accessed 28 Oct 2010
  90. 90.
    National Institute for Health and Clinical Excellence (2008) Alendronate (review), etidronate (review), risedronate (review), raloxifene (review) strontium ranelate and teriparatide (review) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. Technology Appraisal 161. Accessed 28 Oct 2010
  91. 91.
    National Osteoporosis Society (2009) Fighting for fracture liaison services campaign. Accessed 28 Oct 2010
  92. 92.
    The Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians, London (2010) National falls and bone health in older people Accessed 28 Oct 2010
  93. 93.
    Jaglal SB, Hawker G, Cameron C, Canavan J, Beaton D, Bogoch E, Jain R, Papaiouannou A, members of the Osteoporosis Research, Monitoring and Evaluation Working Group (2010) The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada. Osteoporos Int 21:903–908PubMedCrossRefGoogle Scholar
  94. 94.
    Harrington JT, Barash HL, Day S, Lease J (2005) Redesigning the care of fragility fracture patients to improve osteoporosis management: a health care improvement project. Arthritis Rheum 53:198–204PubMedCrossRefGoogle Scholar
  95. 95.
    Harrington JT, Deal CL (2006) Successes and failures in improving osteoporosis care after fragility fracture: results of a multiple-site clinical improvement project. Arthritis Rheum 55:724–728PubMedCrossRefGoogle Scholar
  96. 96.
    Newman ED, Ayoub WT, Starkey RH, Diehl JM, Wood GC (2003) Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years. Osteoporos Int 14:146–151PubMedGoogle Scholar
  97. 97.
    National Coalition for Osteoporosis and Related Bone Diseases (2009) National action plan for bone health: recommendations from the summit for a national action plan for bone health. Accessed 28 Oct 2010
  98. 98.
    US Department of Health and Human Services (2004) Bone health and osteoporosis: a report of the Surgeon General. US Department of Health and Human Services, Office of the Surgeon General Accessed 28 Oct 2010
  99. 99.
    Piscitelli P, Brandi ML, Nuti R, Rizzuti C, Orlandini E, Giorni L, Merlotti D (2010) Pharmacological treatment of hip fractured patients in Italy: a simulation based on Tuscany regional database for the TARGET project. Clin Cases Miner Bone Metab 7(2):140–143Google Scholar
  100. 100.
    Piscitelli P, Rizzuti C, Brandi ML (2010) Undertreatment of hip fractures in Tuscany elderly population. Bone 47(Suppl 1) Available at http://ects2010abstractsondemandcom Accessed 13 Jun 2010
  101. 101.
    Rizzuti C, Girani M, Brandi ML (2009) Use of administrative database in region Tuscany to set goals for triad-like intervention to increase osteoporosis treatment rate and adherence rate after hip fracture. J Bone Miner Res 24(Suppl 1) Available at Accessed 13 Jun 2010

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • D. Marsh
    • 1
  • K. Åkesson
    • 2
    Email author
  • D. E. Beaton
    • 3
    • 9
  • E. R. Bogoch
    • 3
    • 4
  • S. Boonen
    • 5
  • M.-L. Brandi
    • 6
  • A. R. McLellan
    • 7
  • P. J. Mitchell
    • 8
  • J. E. M. Sale
    • 3
    • 9
  • D. A. Wahl
    • 10
  • IOF CSA Fracture Working Group
  1. 1.Institute of Orthopaedics and Musculoskeletal ScienceUniversity College London, Royal National Orthopaedic HospitalStanmoreUK
  2. 2.Department of OrthopedicsSkåne University Hospital MalmöLund UniversitySweden
  3. 3.Mobility Program Clinical Research UnitLi Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  4. 4.Department of Surgery, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  5. 5.Division of Gerontology and Geriatrics and Center for Musculoskeletal Research, Department of Experimental MedicineLeuven UniversityLeuvenBelgium
  6. 6.Department of Internal MedicineUniversity of FlorenceFlorenceItaly
  7. 7.Western Infirmary and University of GlasgowGlasgowUK
  8. 8.School of Health, Faculty of Education, Health and SciencesUniversity of DerbyDerbyUK
  9. 9.Department of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  10. 10.International Osteoporosis FoundationNyonSwitzerland

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