Coordinator-based systems for secondary prevention in fragility fracture patients

Abstract

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.

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Acknowledgments

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.

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Correspondence to K. Åkesson.

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IOF CSA Fracture Working Group: Cyrus Cooper, Jörg Goldhahn, E. Michael Lewiecki, George Lyritis, Karl Obrant, Stuart Silverman, Ethel Siris and Judy Stenmark.

This manuscript has been endorsed by the Committee of Scientific Advisors of the IOF.

A related editorial can be found at doi:10.1007/s00198-011-1643-9; other related articles at doi:10.1007/s00198-011-1534-0, doi:10.1007/s00198-011-1544-y, and doi:10.1007/s00198-011-1638-6.

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Marsh, D., Åkesson, K., Beaton, D.E. et al. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22, 2051–2065 (2011). https://doi.org/10.1007/s00198-011-1642-x

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Keywords

  • Clinical systems
  • FLS
  • Fracture prevention
  • IOF
  • Osteoporosis
  • Osteoporotic fracture