No more excuses: fracture liaison services work and are cost-effective

Markus J Seibel
Med J Aust 2011; 195 (10): . || doi: 10.5694/mja11.11201
Published online: 21 November 2011

Time to find a systems-level model for a serious, undermanaged, but preventable problem

For over 20 years, we have known that osteoporotic fractures predispose to further fractures and significant morbidity.1,2 We also understand that first and subsequent fragility fractures are associated with premature death.2-4 However, surprisingly little has happened over the past two decades to translate this knowledge into good clinical practice for our patients. Of course, anyone presenting with a low-trauma fracture to an Australian hospital will get it fixed in due time. But little happens after that. Nobody seems to ask why that person had a low-trauma fracture (or a second or third one) to begin with. Indeed, 75%–80% of patients who have had an osteoporotic fracture are neither being investigated nor treated for their underlying condition — osteoporosis.5,6 This systematic failure is all the more shocking as we have available to us not only one of the world’s best medical systems, but also subsidised pharmacotherapies with proven efficacy to reduce the risk of (re)fracture.7

  • Concord Clinical School and ANZAC Research Institute, University of Sydney, Sydney, NSW.


Competing interests:

No relevant disclosures.

  • 1. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence. Ann Intern Med 1991; 114: 919-923.
  • 2. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993; 307: 1248-1250.
  • 3. Browner WS, Seeley DG, Vogt TM, Cummings SR. Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 1991; 338: 355-358.
  • 4. Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009; 301: 513-521.
  • 5. Vaile J, Sullivan L, Bennett C, Bleasel J. First Fracture Project: addressing the osteoporosis care gap. Intern Med J 2007; 37: 717-720.
  • 6. Bliuc D, Ong CR, Eisman JA, Center JR. Barriers to effective management of osteoporosis in moderate and minimal trauma fractures: a prospective study. Osteoporos Int 2005; 16: 977-982.
  • 7. Dennison E, Cooper C. Osteoporosis in 2010: building bones and (safely) preventing breaks. Nat Rev Rheumatol 2011; 7: 80-82.
  • 8. New South Wales Department of Health, Agency for Clinical Innovation, Musculoskeletal Network. New South Wales re-fracture admission data 2002–2008. Sydney: ACI, 2010. (accessed Oct 2011).
  • 9. The burden of brittle bones. Epidemiology, costs and burden of osteoporosis in Australia — 2007. Prepared by the Department of Medicine, University of Melbourne, Western Hospital, Footscray, Victoria. http://www.arthritisvic. (accessed Oct 2011).
  • 10. Access Economics. The burden of brittle bones: costing osteoporosis in Australia. Prepared for Osteoporosis Australia. Canberra: Access Economics, 2001. (accessed Oct 2011).
  • 11. Sale JE, Beaton D, Posen J, et al. Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int 2011; 22: 2067-2082.
  • 12. Lih A, Nandapalan H, Kim M, et al. Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int 2011; 22: 849-858.
  • 13. Dell R. Fracture prevention in Kaiser Permanente Southern California. Osteoporos Int 2011; 22 Suppl 3: 457-460.
  • 14. McLellan AR, Wolowacz SE, Zimovetz EA, et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 2011; 22: 2083-2098.
  • 15. Mitchell PJ. Fracture Liaison Services: the UK experience. Osteoporos Int 2011; 22 Suppl 3: 487-494.
  • 16. Cooper MS, Palmer AJ, Seibel MJ. Cost effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study. Osteoporosis Int 2011; 28 Sep [Epub ahead of print].


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