48 Systematic Approaches to Fragility Fracture Care and Prevention: A Global Perspective

Abstract

Abstract Fracture begets fracture. Since the 1980s, we have known that approximately half of individuals who sustain a hip fracture break another bone in the months or years before breaking their hip. More recently, investigators in Australia, the United Kingdom and the United States have reported similar findings. Meta-analyses have demonstrated that a prior fracture at any site is associated with a doubling of future fracture risk. Individuals who sustain fragility fractures usually present to healthcare services to seek medical attention and, as such, represent an obvious group to target for osteoporosis assessment and falls prevention. However, a persistent and pervasive care gap is evident in the secondary prevention of fragility fractures throughout the world. The care gap is well documented in countries in Asia-Pacific. A Fracture Liaison Service (FLS) is a system to ensure fracture risk assessment, and treatment where appropriate, is delivered to all patients with fragility fractures. A FLS is usually comprised of a dedicated case worker, often a clinical nurse specialist, who works to pre-agreed protocols to case-find and assess fracture patients. While FLS are usually based in hospital, some primary care based FLS have been developed. A FLS requires support from a medically qualified practitioner. The FLS model of care has been endorsed and advocated for by governments, healthcare professional organisations and national osteoporosis societies, and national alliances comprised of these and other groups. This presentation will provide a global perspective on implementation of FLS as a central component of a broader systematic approach to fragility fracture care and prevention. References Fracture Liaison Services (FLS) Toolbox for Asia Pacific. Asia Pacific Bone Academy. 2017.