International consensus on 'secondary fracture prevention'
Prof John Eisman
Media Release: 01 August 2012
An international Task Force examining ‘Secondary Fracture Prevention’, initiated and co-chaired by Professor John Eisman from Sydney’s Garvan Institute of Medical Research, and under the aegis of the American Society for Bone and Mineral Research (ASBMR), has published its report in the prestigious Journal of Bone and Mineral Research, now online.
Fragility fractures caused by osteoporosis are common, affecting almost one in two older women and one in three older men. Every fracture signals increased risk of future fractures, as well as risk of premature death.
Secondary fracture prevention entails ‘capturing’ the people who suffer from a fragility fracture and implementing a preventative treatment plan.
At present, there is worldwide under-management of secondary fracture risk. Around 80% of women and 90% of men who sustain a fracture do not receive treatment to reduce their risk of further fracture.
Including 63 clinical care opinion leaders from 36 countries throughout Europe, the USA and Canada, South America, and the Asia-Pacific region, the ASBMR Task Force reviewed the evidence supporting cost-effective interventions and developing a toolkit for reducing secondary fracture incidence.
“Essentially the report says that you need to have in place a systematic approach to capture people who have had fragility fractures,” said Professor Eisman.
“You need to get them assessed and started on treatment while they are still in hospital or at the clinic, rather than just treating their fracture and sending them home.”
“The biggest challenge across the globe is that people are discharged from hospital - having been told their fracture has been treated and fixed, which of course it has - without getting an appropriate assessment to make sure that they don’t have another fracture.”
“We know that the vast majority of people do not get treatment when they should – and the evidence is that this literally shortens their life expectancy.”
“There are several drugs that are well tolerated and proven to be effective, offering people a better quality of life for longer.”
“It’s encouraging that the UK has now formally introduced the policy that part of a GP’s pay relates to how well they manage fragility fractures. If they do it well, they get extra money; if they do it badly, they get less money. This process is helping to ensure that all patients are assessed.”
“In Australia, through an initiative called the HELLO program, we’re trying to build a three-legged stool. We want patients to be assessed and have a clear treatment plan before they leave the hospital; we want to educate the general public so they understand what we’re doing and why; and we want to improve general practitioners’ knowledge, so they more fully understand the different treatments and when and how they should be used.”
“If you don’t capture the patients in the hospital, nothing happens; if you capture the patients but they don’t understand the issues, they won’t adhere to any plan long-term; and if the GPs don’t have a thorough understanding of the issues, they won’t be able to inform, encourage and support their patients in their long-term adherence. So you really need all three things – the three legs of the stool. It’s very much what I’m trying to do.”