Delivering assessment & treatment for fracture secondary prevention: A global problem

Osteoporosis is a major public health burden with substantial impact of the causally related fragility fractures on morbidity, premature mortality and health care costs. It is clear that hip fractures constitute a large part of this impact but it is equally clear that a wide range of fragility fractures not only signal increased risk of future fractures, including hip fractures, but that these other non-hip fractures occur in younger individuals, both men and women. All of these fragility fractures signal increased risk of future fracture, generate major health care costs and are associated with premature mortality. Almost thirty years ago, investigators from the Mayo Clinic in the US demonstrated that over half of patients presenting with hip fractures had experienced a prior fragility fracture. Recent studies from Scotland, Australia and the USA have consistently confirmed this earlier finding. Accordingly, targeting all older patients who present with fragility fractures at any skeletal site for integrated bone health and falls risk assessment provides a means to intervene in up to a half of all future hip fracture cases. A systematic approach to prevention of fragility fractures is urgently required as the global demographic shift results in a rapidly aging human population.