Osteoporosis International

, Volume 26, Issue 11, pp 2573–2578 | Cite as

Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool

  • M. K. Javaid
  • C. Kyer
  • P. J. Mitchell
  • J. Chana
  • C. Moss
  • M. H. Edwards
  • A. R. McLellan
  • J. Stenmark
  • D. D. Pierroz
  • M. C. Schneider
  • J. A. Kanis
  • K. Akesson
  • C. CooperEmail author
  • IOF Fracture Working Group
  • EXCO
Original Article



Fracture Liaison Services are the best model to prevent secondary fractures. The International Osteoporosis Foundation developed a Best Practice Framework to provide a quality benchmark. After a year of implementation, we confirmed that a single framework with set criteria is able to benchmark services across healthcare systems worldwide.


Despite evidence for the clinical effectiveness of secondary fracture prevention, translation in the real-world setting remains disappointing. Where implemented, a wide variety of service models are used to deliver effective secondary fracture prevention. To support use of effective models of care across the globe, the International Osteoporosis Foundation’s Capture the Fracture® programme developed a Best Practice Framework (BPF) tool of criteria and standards to provide a quality benchmark. We now report findings after the first 12 months of implementation.


A questionnaire for the BPF was created and made available to institutions on the Capture the Fracture website. Responses from institutions were used to assign gold, silver, bronze or black (insufficient) level of achievements mapped across five domains. Through an interactive process with the institution, a final score was determined and published on the Capture the Fracture website Fracture Liaison Service (FLS) map.


Sixty hospitals across six continents submitted their questionnaires. The hospitals served populations from 20,000 to 15 million and were a mix of private and publicly funded. Each FLS managed 146 to 6200 fragility fracture patients per year with a total of 55,160 patients across all sites. Overall, 27 hospitals scored gold, 23 silver and 10 bronze. The pathway for the hip fracture patients had the highest proportion of gold grading while vertebral fracture the lowest.


In the first 12 months, we have successfully tested the BPF tool in a range of health settings across the globe. Initial findings confirm a significant heterogeneity in service provision and highlight the importance of a global approach to ensure high quality secondary fracture prevention services.


Adherence Best Practice Framework Falls prevention Fracture Liaison Service Hip fracture Osteoporosis Secondary fracture prevention Vertebral fracture 



The authors would like to thank all the FLS applicants for taking part of the Capture the Fracture programme.

Conflicts of interest


Supplementary material

198_2015_3192_MOESM1_ESM.pdf (196 kb)
ESM 1 (PDF 196 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • M. K. Javaid
    • 1
  • C. Kyer
    • 2
  • P. J. Mitchell
    • 3
    • 4
  • J. Chana
    • 5
  • C. Moss
    • 6
  • M. H. Edwards
    • 6
  • A. R. McLellan
    • 7
  • J. Stenmark
    • 2
  • D. D. Pierroz
    • 2
  • M. C. Schneider
    • 2
  • J. A. Kanis
    • 8
  • K. Akesson
    • 9
  • C. Cooper
    • 1
    • 6
    Email author
  • IOF Fracture Working Group
  • EXCO
  1. 1.NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of OrthopaedicsUniversity of OxfordOxfordUK
  2. 2.International Osteoporosis Foundation (IOF)NyonSwitzerland
  3. 3.Synthesis Medical NZ LtdAucklandNew Zealand
  4. 4.University of Notre Dame AustraliaSydneyAustralia
  5. 5.Stoke Mandeville HospitalAylesburyUK
  6. 6.MRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton General HospitalSouthamptonUK
  7. 7.EndocrinologyWestern InfirmaryGlasgowUK
  8. 8.Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  9. 9.Department of OrthopaedicsLund University, Skåne University HospitalMalmöSweden

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