Strategies for more effective fracture secondary prevention in Canada

Fragility fractures are a strong indicator of underlying osteoporosis and are often followed by further fragility fractures. The literature demonstrates an absence of identification and intervention in these high-risk patients. Since fracture patients are usually first treated in fracture clinics or emergency departments, orthopedic surgeons  represent a consistent early contact for these patients. Therefore, efforts to improve rates of investigation and treatment of osteoporosis in fragility fracture patients may best be directed toward orthopedic surgeons. Barriers to care include crowded fracture clinics with long wait times, surgeons’ lack of knowledge and experience in osteoporosis care, busy family physicians with limited time and knowledge, and patients’ lack of knowledge and awareness. In Canada, there are many published randomized control trials and osteoporosis intervention programs which all have varied levels of success depending on the model of care implemented. The coordinator model, in which a person is designated to identify fragility fracture patients, educates patients on osteoporosis and their risks, arranges bone health investigation and follow-up with the family physician or specialist for further treatment of their bone health, is a model that has shown great success. In Ontario, the provincial government funds a multifacted Osteoporosis Strategy, in which a Post-Fracture Osteoporosis component has been implemented. This program has deployed 19 coordinators in 33 fracture clinics across Ontario in order to improve osteoporosis diagnosis and treatment, prevent future fractures, and improve osteoporosis knowledge among health professionals and patients. The coordinator model has been showen to be cost savings for the hospitals, improve patient outcomes and change physician behaviours. Effective osteoporosis care after a patient has sustained a fragility fracture is a complex process involving several steps between recognition of the fracture and effective prevention of future fractures.