The "P3" Concept Or How to Make Secondary Fracture Prevention Become the Orthotrauma Surgeon's Baby.

Abstract

Because of demographic change, we treat patients with fragility fracture on a daily basis. As a matter of fact, we therefore hold the pole position to identify those patients who are eligible for measures of secondary fracture prevention. For more than 20 years, our performance in doing so has received poor ratings. Multifaceted measures did not succeed to create significant change in this until recently. In view of the solid evidence that proves the effectiveness of measures for secondary fracture prevention in general and for specific pharmacotherapy in special, this situation awaits a change. The following question therefore arises: What has prevented us from following this ‘‘call to action’’ in the past? The former approach was to add secondary fracture prevention as an additional task to our daily schedule. To make things even worse, the typical setting our residents meet in the emergency department when treating patients with fragility fracture is not adequate at all to address osteoporosis as a chronic disease. Finally, depending on the reimbursement of the national health-care system, there may be no or only minimal financial incentives on the individual health-care providers level in case of initiation of measures for secondary fracture prevention. To summarize, the rationale to change our attitude toward secondary fracture prevention was too little for most of us in the past.