Reducing the burden of osteoporosis-related fractures

Research by Monash University suggests that without intervention, the total number of hip fractures globally could nearly double by 2050.

The World Health Organization has identified osteoporosis as a major global health issue because it poses significant risks of disability and premature death. Osteoporosis-related fractures are a leading cause of disability and long-term care needs for older adults, with hip fractures being particularly devastating.

Published in a Perspective article in the New England Journal of Medicine, new research highlights that fracture liaison services (FLS) play a critical role in addressing the growing global burden of osteoporosis-related fractures. It reported that within the first 12 months following a hip fracture, mortality rates range from 14.4% to 28.3% for community-dwelling individuals and up to 55% for residents of long-term care facilities.

Designed to bridge the disconnect between acute fracture care and long-term osteoporosis management, FLS are specialised programs that ensure patients who experience a fragility fracture (low-impact fractures that indicate osteoporosis) are systematically identified, assessed, and treated to prevent future fractures.

Monash Health’s School of Clinical Sciences and Department of Medicine Head and author of the paper, Professor Peter Ebeling AO, argued that these services can also deliver a return of $10.49 for every $1 invested. Health care systems like Kaiser Permanente in the USA, which have successfully implemented FLS, report significant reductions in fracture rates, underscoring the cost-effectiveness of this approach.

The article outlines four FLS models, which may include medication, lifestyle modifications such as exercise and fall prevention education, and coordination between primary and specialty care providers. FLS programs have been shown to reduce the risk of secondary fractures by up to 74% in the first year and 32% in subsequent years.

However, despite advancements in treatment, less than 20% of all patients who experience fragility fractures receive the recommended pharmacologic treatments to strengthen bone and prevent further fractures.

This gap underscores the importance of post-fracture care programs like FLS. “The burden of fragility fractures on healthcare systems is substantial, demanding coordination across multiple specialties including primary care, geriatrics, orthopaedics and rehabilitation,” Ebeling said.

“Countries like the United Kingdom, Australia and Japan already benefit by implementing FLS. The problem in the US is the current lack of reimbursement for FLS-related services, which decreases the likelihood of healthcare institutions’ decisions to invest in FLS offerings. This is really a missed opportunity for fracture prevention and improved patient outcomes.”

Ongoing advocacy efforts by organisations, such as Healthy Bones Australia, aim to increase FLS in Australia. This would allow healthcare providers to establish and sustain FLS programs, ultimately reducing the burden of osteoporosis-related fractures nationwide.

Image credit: iStock.com/Cecilie_Arcurs