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Curr Osteoporos Rep. 2019 Nov 16. doi: 10.1007/s11914-019-00544-8. [Epub ahead of print]

Quality Improvement Initiatives in Fragility Fracture Care and Prevention.

Mitchell PJ1,2,3, Cooper C4,5,6,7, Fujita M7, Halbout P7, Åkesson K7,8,9, Costa M10,11, Dreinhöfer KE10,12,13, Marsh DR10,14, Lee JK15,16, Chan DD17,18, Javaid MK6,7.

Author information

1
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. paul.mitchell@ndorms.ox.ac.uk.
2
School of Medicine, Sydney Campus, The University of Notre Dame Australia, 140 Broadway, Sydney, NSW, 2007, Australia. paul.mitchell@ndorms.ox.ac.uk.
3
Fragility Fracture Network, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland. paul.mitchell@ndorms.ox.ac.uk.
4
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
5
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
6
NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
7
International Osteoporosis Foundation, 9 rue Juste-Olivier, CH-1260, Nyon, Switzerland.
8
Department of Orthopaedics, Skane University Hospital, Malmö, Sweden.
9
Department of Clinical Sciences, Lund University, Malmö, Sweden.
10
Fragility Fracture Network, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland.
11
Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
12
Department of Musculoskeletal Rehabilitation, Prevention and Health Service Research, Center for Sport Science and Sport Medicine (CSSB), Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin, Berlin, Germany.
13
Department of Orthopedics and Traumatology, Medical Park Berlin Humboldtmühle, Berlin, Germany.
14
University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.
15
Department of Orthopedic Surgery, Beacon International Specialist Centre, Petaling Jaya, Selangor, Malaysia.
16
Advanced Neuroscience and Orthopedic Centre (ANOC), Kuala Lumpur, Malaysia.
17
Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
18
Superintendent Office, Chutung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan.

Abstract

PURPOSE OF REVIEW:

This review sought to describe quality improvement initiatives in fragility fracture care and prevention.

RECENT FINDINGS:

A major care gap persists throughout the world in the secondary prevention of fragility fractures. Systematic reviews have confirmed that the Fracture Liaison Service (FLS) model of care is associated with significant improvements in rates of bone mineral density testing, initiation of osteoporosis treatment and adherence with treatment for individuals who sustain fragility fractures. Further, these improvements in the processes of care resulted in significant reductions in refracture risk and lower post-fracture mortality. The primary challenge facing health systems now is to ensure that best practice is delivered effectively in the local healthcare setting. Publication of clinical standards for FLS at the organisational and patient level in combination with the establishment of national registries has provided a mechanism for FLS to benchmark and improve their performance. Major efforts are ongoing at the global, regional and national level to improve the acute care, rehabilitation and secondary prevention for individuals who sustain fragility fractures. Active participation in these initiatives has the potential to eliminate current care gaps in the coming decade.

KEYWORDS:

American Society for Bone and Mineral Research; Asia Pacific Fragility Fracture Alliance; Capture the Fracture®; Fracture Liaison Service; Fracture prevention policy; Fragility Fracture Network; Fragility fracture; International Osteoporosis Foundation; Orthogeriatric Services; Osteoporosis; Secondary fracture prevention; Systems-based approach

PMID:
31734907
DOI:
10.1007/s11914-019-00544-8

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