The American Society for Bone and Mineral Research’s task force of international experts is calling on healthcare providers to routinely provide osteoporosis testing and to start therapy as needed for all adults above the age of 50 who have sustained their first osteoporosis-related fracture in an attempt to prevent subsequent fractures.
The experts were commissioned to conduct an extensive review of possible solutions to prevent “secondary fractures,” and determined that the most effective solution would be a system of patient care coordination called “fracture liaison services”. Their findings are published online in the Journal of Bone and Mineral Research.
According to research, these services have shown a considerable improvement in follow-up assessment and treatment after an initial fracture was sustained and therefore lower the risk of additional fractures. The team found that biggest hurdle that needs to be overcome for using the model more extensively is lack of insurance coverage.
The Society aims to achieve a 20% reduction in hip fractures by 2020, as by this time the U.S. and other countries are predicted to experience an influx of fractures due to the aging population.
Ethel S. Siris, M.D., co-chair of the task force, explains: “Fractures beget fractures and lead to untold suffering. Our task force looked at ways to break this vicious cycle. We learned what works and what doesn’t. The research is clear: fracture liaison services are saving suffering, and they are saving money.”
Every year, nearly 300,000 older people in the U.S. sustain a hip fracture, and over 20% die within a year of their injury. Hip fractures are often the most serious and most expensive type of fracture. A recent study revealed that the Kaiser Permanente “Healthy Bones” model of care, a fracture liaison service program, has demonstrated that programs like theirs can reduce the number of hip fractures by nearly 40%, and if implemented nationally, these programs can save almost $3 billion per year.
Siris, an osteoporosis expert at the College of Physicians and Surgeons of Columbia University in New York, said:
“The increasing incidence of osteoporosis-related fractures is a public health disaster – one that already causes untold suffering and is slated to add $25 billion to the nation’s health care costs by 2025. We know that once a first fracture occurs the risk of additional fractures is high. Targeting these individuals for treatment to reduce the possibility of more fractures will save a lot of human suffering and tremendous expense to the health care budget.”
According to Siris, even though emergency room physicians and orthopedic surgeons demonstrate excellent workmanship in repairing first fractures, there is a distinct gap between the “fracture fixer and the fracture preventer” in providing medical treatment for osteoporosis. This gap can be bridged by fracture liaison service coordinators, who play a vital role in patient education, ensuring the patient is seen for medical management and to follow up on the patient’s adherence of taking necessary medications to prevent future fractures.
The expert task force conducted the so far most comprehensive review on secondary fracture prevention to date, and highlight that the results support widespread implementation of and insurance coverage for fracture liaison services of patients over the age of 50 who already sustained a fracture. At present there are only very few insurers that cover paying for the services of a fracture liaison service coordinator.
Secondary fractures are often caused by undiagnosed or untreated osteoporosis and represent a growing public health crisis due to the world’s aging population. The concept of having fracture liaison service coordinators is evidently very effective in addition to reducing health costs. The cost of employing fracture liaison service coordinators is relatively inexpensive and research has proven that paying for such care is a sound investment in providing two major benefits, an effective prevention of secondary fractures and saving cost.
Keith Hruska, M.D., ASBMR president points out:
“This report is a health delivery breakthrough even if it is not a clinical breakthrough, and it will definitely benefit patients if implemented. With the increasing attention paid these days on cutting costs in health systems, this research is a great example of comparative effectiveness research. We have a road map for what treatment systems are the most effective for osteoporosis patients and most cost effective as well.”
Several different U.S. initiatives and abroad are already pushing to implement coordination groups to treat and manage fractures. However, the experts advise that a cooperative approach could potentially magnify the effort to get solutions in place. They have recommended a central clearing house to accelerate the progress to identify the best practices and help providers and others in tackling fracture prevention.
Written by Petra Rattue