After a fragility fracture, follow-up can miss the chance to investigate osteoporosis, start treatment and review medicines linked with fracture risk. A fracture liaison service can connect hospital care with primary care so these steps have a coordinator and a handoff.
The fracture may not lead to osteoporosis care
Osteoporosis as a cause of fracture is often not investigated or treated, according to Dr. Singh of Fraser Health. She said treatment options can reduce the risk of new fractures by up to 50 percent, and described the need to offer investigation and treatment at the point of care (I1861).
A study of 1,103 people hospitalized for hip fracture in a fracture liaison service cohort found that 82, or 7.4 percent, had received anti-osteoporosis treatment before their fracture (I693). That figure describes treatment before the index fracture in this cohort. It points to a gap that follow-up systems can address by making assessment and treatment part of the pathway after a fracture.
Medication review can fall through
A Medicare study found that more than three-quarters of patients with a fragility fracture had been prescribed a fracture-risk-increasing drug in the four months before the fracture. The share taking at least one such drug in the four months after fracture was nearly identical (I2069).
Dr. Munson said the care team should ideally review and reduce use of medicines that could contribute to later fractures. The study suggests this review was not happening consistently, which may be a missed opportunity to prevent further fractures (I2070). Medication changes are individual decisions, so patients should discuss them with their own doctor.
A coordinator can connect the handoff
The International Osteoporosis Foundation describes the typical post-fracture pathway as a fracture liaison service, usually delivered by a nurse coordinator, linking hospital care with primary care (I1864). Fraser Health describes a model in which a coordinator works with orthopedic surgeons and meets patients in the orthopedic clinic after initial post-fracture care (I1863).
For a practice, one concrete operational step is to name who receives the post-fracture handoff and follows up on osteoporosis assessment, treatment and medication review. The coordinator model gives that work a point of contact across the hospital and family practice. Without a clear handoff, those follow-up tasks may not have an obvious owner.
Falls assessment matters in long-term care
Osteoporosis Canada's 2015 long-term care fracture prevention recommendations include an integrated falls and osteoporosis assessment, along with treatment strategies for a population not usually considered when treatment approaches are developed (I1995). This recommendation is specific to long-term care, where fall risk and bone health are addressed together.
The setting matters when planning follow-up. A care pathway for a long-term care resident may need to bring falls and osteoporosis assessment into the same process, while a hospital to primary care pathway needs a coordinator to connect the settings. These examples point to a practical question for teams: who checks that the assessment and treatment plan move forward after discharge?
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
How common was osteoporosis treatment before hip fracture in one study?
In a cohort of 1,103 patients hospitalized for hip fracture and served by a fracture liaison service, 82 people, or 7.4 percent, had received anti-osteoporosis treatment before the fracture (I693). This describes that cohort, not all people who experience hip fracture.
What outcomes were reported for an interdisciplinary fracture liaison pathway?
The authors reported better adherence to anti-osteoporosis treatment started promptly after hip fracture repair and fewer healthcare facility admissions related to adverse events among patients in the interdisciplinary pathway (I1874).
When can falls be a concern after a hospital stay?
CDC says older adults are more likely to fall during the first month after hospital discharge than older adults who have not been hospitalized. It says hospitals can help by incorporating fall prevention into routine clinical practice (I1721).
Sources
- Service that helps avoid recurring bone fractures in middle aged and older patients moves from prototype to regular practice. (Fraser Health)
- Estimating the Extent of Missed Opportunities for Osteoporosis Treatment Before Hip Fracture Occurrence (Calcified Tissue International)
- Patients Remain On High Risk Drugs Even After A Fragility Fracture (MedicalResearch.com)
- IOF president interviewed on health professional radio (International Osteoporosis Foundation (Capture the Fracture))
- Long Term Care | Osteoporosis Canada (Osteoporosis Canada)
- The interdisciplinary fracture liaison service improves health-related outcomes and survival of older adults after hip fracture surgical repair (Archives of Osteoporosis)
- Inpatient Care | STEADI - Older Adult Fall Prevention | CDC (Centers for Disease Control and Prevention)
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