May 31, 2011
New IOF position paper recommends coordinator-based
systems to manage fragility fracture patients– potential for
at least 25% reduction of hip fractures versus the expected
rate
A prior fracture at least doubles a patient’s future fracture
risk – yet numerous studies from across the world have found
that healthcare systems fail to respond to the first fracture to
prevent future fractures. Professor Cyrus Cooper, chair of the
Committee of Scientific Advisors of the International Osteoporosis
Foundation (IOF) and director of the MRC Lifecourse Epidemiology
Unit, University of Southampton in the UK stated, “Studies
from the UK, USA and Australia have reported that 45% or more of
today’s hip fracture patients have a prior fracture history.
Healthcare systems are evidently failing to respond to the first
fracture – this is, tragically, a missed opportunity for
intervention. Worldwide, millions of people go on to experience
debilitating and life-threatening hip fractures, at great cost to
the individual and to healthcare systems.”
A new position paper issued today by IOF concludes that
coordinator-based systems are the most clinically- and
cost-effective models to optimise outcome in fragility fracture
patients, helping to improve diagnosis and treatment of
osteoporosis in high risk patients for the prevention of secondary
fractures. The position paper emphasises the need for
coordinator-based models, considers practical experience that is
transferable between healthcare systems and describes steps to
achieve consensus amongst professionals, patients and
policymakers.
Professor Kristina Åkesson, of the Department of Orthopedics,
Skåne University Hospital Malmö, Lund University in
Sweden, and chair of the IOF Fracture Working Group said,
“The coordinator, often a nurse or nurse practitioner, acts
as a liaison between the orthopaedist, other specialists, the
patient and the primary care physician to ensure that that the
patient receives coordinated, comprehensive and customized
intervention and follow-up. Without this kind of systematic and
coordinated approach, there is often a lack of clear responsibility
and the patient is liable to fall into what is termed a ‘care
gap’.”
The cost-effectiveness of coordinator-based models has been
established in several studies. A Canadian study showed that, at a
cost of $12 per patient, for every 100 patients receiving
intervention three fractures (including one hip fracture) were
avoided, resulting in $26,800 saved by the healthcare system. A
recent health economic analysis in the UK determined that cost
savings from national implementation of a Fracture Liaison Service
such as the one used in Glasgow, Scotland, would potentially amount
to £8.5 million over five years. US studies have also shown
that aggressive osteoporosis programmes in integrated healthcare
systems can reduce the risk of fractures and ultimately save
money.
“This Position Paper provides a clear outline of best
practice in an international context and suggests steps in
implementing effective post-fracture coordinator-based models. We
also hope that it will serve as a reference to help convince key
stakeholders – health policy makers, professional societies and
patient organizations – of the urgent need for improved secondary
prevention of fractures, “ commented co-author of the report,
Professor David Marsh of the Institute of Orthopaedics and
Musculoskeletal Science, University College London. He added,
“If we fail to take action, our healthcare systems will be
overwhelmed by an avalanche of fractures in our ageing
populations.“
The IOF Position Paper, published in ‘Osteoporosis
International’, is freely accessible at http://www.springerlink.com/content/e81n020693737705/
for a three-month period.
Coordinator-based systems for secondary prevention in fragility
fracture patients.
D. Marsh, K. Åkesson, D. E. Beaton, E. R. Bogoch, S. Boonen,
M.-L. Brandi, A. R. McLellan, P. J. Mitchell, J. E. M. Sale, D. A.
Wahl and the IOF CSA Fracture Working Group (2011)
Osteoporos Int DOI: 10.1007/s00198-011-1642-x
Additional reading: Editorial – Breaking the fragility
fracture cycle. C. Cooper, P. Mitchell, J. A. Kanis (2011)
Osteoporos Int DOI 10.1007/s00198-011-1643-9
View article at http://www.springerlink.com/content/n565w0585521k100/
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