Osteoporosis International

, Volume 24, Issue 2, pp 393–406 | Cite as

Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis

  • K. GandaEmail author
  • M. Puech
  • J. S. Chen
  • R. Speerin
  • J. Bleasel
  • J. R. Center
  • J. A. Eisman
  • L. March
  • M. J. SeibelEmail author


Most people presenting with incident osteoporotic fractures are neither assessed nor treated for osteoporosis to reduce their risk of further fractures, despite the availability of effective treatments. We evaluated the effectiveness of published models of care for the secondary prevention of osteoporotic fractures. We searched eight medical literature databases to identify reports published between 1996 and 2011, describing models of care for secondary fracture prevention. Information extracted from each publication included study design, patient characteristics, identification strategies, assessment and treatment initiation strategies, as well as outcome measures (rates of bone mineral density (BMD) testing, osteoporosis treatment initiation, adherence, re-fractures and cost-effectiveness). Meta-analyses of studies with valid control groups were conducted for two outcome measures: BMD testing and osteoporosis treatment initiation. Out of 574 references, 42 articles were identified as analysable. These studies were grouped into four general models of care—type A: identification, assessment and treatment of patients as part of the service; type B: similar to A, without treatment initiation; type C: alerting patients plus primary care physicians; and type D: patient education only. Meta-regressions revealed a trend towards increased BMD testing (p = 0.06) and treatment initiation (p = 0.03) with increasing intensity of intervention. One type A service with a valid control group showed a significant decrease in re-fractures. Types A and B services were cost-effective, although definition of cost-effectiveness varied between studies. Fully coordinated, intensive models of care for secondary fracture prevention are more effective in improving patient outcomes than approaches involving alerts and/or education only.


Cost-effectiveness Fracture liaison services Models of care Osteoporosis treatment Re-fractures Secondary fracture prevention 


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • K. Ganda
    • 1
    Email author
  • M. Puech
    • 2
  • J. S. Chen
    • 3
  • R. Speerin
    • 4
  • J. Bleasel
    • 5
  • J. R. Center
    • 6
  • J. A. Eisman
    • 6
    • 7
    • 8
    • 9
  • L. March
    • 3
  • M. J. Seibel
    • 1
    Email author
  1. 1.Department of Endocrinology and Metabolism, Bone Research Program, ANZAC Research InstituteThe University of SydneyConcordAustralia
  2. 2.Public Health Unit-Hornsby OfficeHornsby Ku-ringai HospitalHornsbyAustralia
  3. 3.Institute of Bone and Joint ResearchThe University of SydneySydneyAustralia
  4. 4.Musculoskeletal NetworkAgency for Clinical InnovationChatswoodAustralia
  5. 5.Royal Prince Alfred HospitalCamperdownAustralia
  6. 6.Osteoporosis and Bone Biology Program, Garvan Institute of Medical ResearchSydneyAustralia
  7. 7.St Vincent’s Hospital Clinical SchoolThe University of New South WalesSydneyAustralia
  8. 8.School of MedicineThe University of Notre DameSydneyAustralia
  9. 9.Department of EndocrinologySt Vincent’s HospitalSydneyAustralia

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