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Even though effective treatments can substantially reduce the risk of breaking another bone, less than 25% of patients receive effective preventative management after a broken bone.

The aim of these workpackages are to close this clinical care gap through disseminating good practice and improving the evidence base in secondary fracture prevention.

AIMS

We aim to provide a platform to spread good practice in secondary fracture prevention so every patient aged 50 and over with a fragility fracture in South Central is systematically identified, investigated and receives effective management of both bone health and falls prevention for at least five years.

The Fracture Free study aims to extend our understanding of the causes and consequences of fragility fracture and compare aspects of secondary fracture prevention across the UK.

Findings from this study will be used to inform local and national fracture prevention services to achieve the National Osteoporosis Society's goal of a fracture free future.

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Image: Map of our area.

Background

Osteoporosis and fragility fractures are potentially devastating and remain underestimated by both the public and clinicians.

This is evidenced by the lack of awareness amongst those who fracture of the need to have an assessment for osteoporosis (1) and also the very poor adherence to therapy (2). Among clinicians this is evidenced by the at best patchy provision of commissioned secondary prevention services across the UK (3).

The Department of Health (DoH) Falls and Fragility Fracture Strategy suggests a step down pyramid of cost effective strategies (4). Efficient management of the hip fracture patient is the first tier followed by case finding for secondary prevention in primary and secondary care as the second tier before strategies for primary prevention in the at high risk group.

Despite the DoH recommendation of secondary prevention of fragility fracture as a cost effective model of health care, uptake of fracture liaison services (FLS) is low in England primarily because the economic modelling is not based on UK trial data but extrapolated from estimated therapeutic benefit from existing FLSs (5).

For a secondary prevention service to be effective, it must capture as many patients as possible who are at risk of refracture (6) as well as ensure prescribed therapies are adhered to with a medication possession ratio of at least 80% (7).

There is consistent pharmaco-epidemiological evidence demonstrating unacceptable continuation of osteoporotic therapies at 6 months, with rate of 50% (2). The poor persistence is associated with an increased risk of fracture (7).

Further, even though up to 20% of patients presenting from a hip fracture are from care homes, these patients often do not receive bone protection due to clinical concerns regarding risks and benefits in terms of their frailty and cognitive impairment. In addition, most of our understanding of the causes and consequences of fragility fracture are from non-NHS health care systems.

 References

  1. Siris ES, Gehlbach S, Adachi JD, Boonen S, Chapurlat RD, Compston JE, et al. Failure to perceive increased risk of fracture in women 55 years and older: the Global Longitudinal Study of Osteoporosis in Women (GLOW). Osteoporos Int. 2011;22(1):27-35. 
  2. Sheehy O, Kindundu CM, Barbeau M, LeLorier J. Differences in persistence among different weekly oral bisphosphonate medications. Osteoporos Int. 2009;20(8):1369-76. 
  3. Treml J, Husk J, Lowe D, Vasilakis N. Falling standards, broken promises: Report of the national audit of falls and bone health in older people in 2010. Royal College of Physicians, Partnership HQI; 2011. 
  4. DH/SC LCdOPaD. Falls and fractures: Effective interventions in health and social care. In: Health Do, editor. 2009. 
  5. DH/SC LCdOPaD. Fracture prevention services An economic evaluation. In: Health Do, editor. 2009. 
  6. Siris ES, Brenneman SK, Barrett-Connor E, Miller PD, Sajjan S, Berger ML, et al. The effect of age and bone mineral density on the absolute, excess, and relative risk of fracture in postmenopausal women aged 50-99: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int. 2006;17(4):565-74. 
  7. Danese MD, Badamgarav E, Bauer DC. Effect of adherence on lifetime fractures in osteoporotic women treated with\ daily and weekly bisphosphonates. J Bone Miner Res\. 2009;24\(11\):1819-26\. 8. Gallacher SJ. Setting up an osteoporosis fracture liaison service: background and potential outcomes. Best Pract Res Clin Rheumatol. 2005;19(6):1081-94.

Our Network

We are a network of every bone clinician / practitioner in the South Central Region led by:

  • Milton Keynes
    A Jenkins
  • Stoke Mandeville
    M Magliano, J Sutherington, H Brain
  • Horton
    A Kannan
  • John Radcliffe, Oxford
    Kassim Javaid, K Rance, S Hope, C Pulford, K Shah
  • Wexham Park
    M Adler
  • Reading
    J Lippett, K Hicklin, J McNally, G MacDonald
  • Basingstoke
    E Corbett, R Moitra
  • Winchester
    A Cooper
  • Southampton
    G Pearson, M Baxter, N Harvey, Z Cole, C Cooper
  • Portsmouth
    S Young-Min, C Beevor, S Poulton, A Finnegan
  • Isle of Wight
    M Pugh, C Sunderland
  • Birmingham
    A Doyle, N Gittoes
  • Salisbury
    R Smith