Strategies for more effective fracture secondary prevention in Oceania

Given the clinical importance of osteoporosis in increased fragility fracture risk, increased subsequent fracture risk and premature mortality, health care to reduce the risk of further fractures is a high public health priority.  However, even in highly advanced health care systems, less than 25% of women and less than 10% of men, with prior fragility fractures, receive care designed specifically to reduce their risk of further fractures.
The major barriers to treating those at increased risk of a fragility fracture are considered to be primarily lack of certainty about the absolute risk, the health importance of such fractures, the balance of benefits and side effects of interventions and the persons/organisations responsive for the initiation and maintenance of such approaches.
Unsuccessful approaches primarily are characterised by dependence upon individuals without a specific interest and/or passing responsibility onto the “patient” or their primary health care provider without adequate support.
Successful approaches within the “free health care model” in the Australian health care system are characterised by a systems-based approach with local ‘champions” being involved in assessment as part of the management of the fragility fracture..
The data presented support the characteristics and cost-effectiveness of a systems-based health care improvement approach to achieve high levels of appropriate assessment and treatment initiation.