Well-designed secondary fragility fracture prevention services (SFFPS) are of major importance in reducing the health burden of fragility fractures. Understanding how SFFPS are taking place in different countries and continents can help develop a comprehensive global strategy to support high quality SFFPS for patients worldwide.


This is the first international survey describing SFFPS on a global level. The authors explored the gaps in SFFPS and the needs for further training and mentorship to improve the quality of services provided to patients who sustain fragility fractures.


This cross-sectional study involved 69 respondents (orthopaedic surgeons, geriatricians, nurses, physiotherapists and researchers) from 34 countries, over six continents and used a 50-item questionnaire about the services and interventions provided, patient follow-up, electronic record keeping, key performance indicators (KPI)/quality indicators, barriers and facilitators to providing services.


Important positive findings were that the majority of services connected with patients with fragility at the time of their fracture in the hospital, included all fracture types, operated 5 days/week or more and used local, national or international guidelines to structure their services. In addition, the majority of services conducted one-on-one in-person assessments, created care plans in collaboration with patients and/or family, started or recommended medications to prevent future fragility fractures and undertook follow-up to ensure treatment persistence.


The study identified several key areas for improvement of SFFPS:

Facilitators to SFFPS included support of colleagues, teamwork/staff engagement and administrative support.  Barriers to SFFPS included lack of funding, lack of staff, technology and database issues and a lack of interest by health providers and patients.


Dr Sonia Singh, one of the authors, stated: ‘Our survey results have provided a preliminary overview of how SFFPS are operating around the world and highlighted some gaps in care, in addition to identifying opportunities for mentorship and training that we plan to incorporate into our future SIG initiatives. We need to find better ways to communicate to both patients and policy makers the imperative of moving secondary fragility fracture prevention to the top of the list of healthcare priorities.'

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Pre-hospital delays and comorbidities are risk factors for short-term mortality following hip fractures in geriatric patients.

Surgery is recommended within 24-48 hours for geriatric hip fractures. In developing countries, however, delayed presentation to the hospital due to various factors often precludes surgery from occurring within these recommended intervals. This study was undertaken in India and included 78 geriatric patients, in order to identify the hurdles that prevent early surgery for geriatric hip fractures and assess their effect on mortality.


 The results of the study indicated that:

According to the authors, the findings of this study underline the need to generate awareness, improve the referral chain, and set up protocol-based care in hospitals to reduce the delay in presentation to the hospital. Further studies are required to assess the socio-economics of delayed treatment of geriatric hip fractures in developing countries.

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Fractures are a public health issue that severely affects people, their caregivers, and the healthcare systems. As people age, a failure to ensure good bone health can cause fractures and lead to a loss of mobility and independence. Older adults who sustain a fracture are at very high risk of sustaining subsequent fractures. Interventions are needed to address fractures in general and secondary fractures specifically. 


The Global Coalition on Aging’s Bone Health Initiative released “Improving Bone Health in the UN Decade of Healthy Ageing,” providing a snapshot of the importance of bone health to healthy aging and the need to implement effective intervention in the form of Fracture Liaison Services, a proven, integrated model of care which provides personalized care to help prevent secondary fractures. The Bone Health Initiative calls on global and national policymakers, officials in age-friendly cities and communities, healthcare professionals, patient advocacy organizations, employers concerned about the health and employability of older employees, and other societal stakeholders to join in advocating for the adaptation and prioritization of Fracture Liaison Services to prevent secondary fractures. FFN is participating actively in this Initiative.

Global Coalition on Aging Bone Health Initiative

The Global Coalition on Aging (GCOA) convened its Bone Health Initiative (BHI) in 2022 with the goal of elevating bone health on the global public health agenda. By bringing together a partnership of leading scientists, clinicians, policy experts, advocates and business  leaders with expertise from across osteoporosis, aging and public health, the BHI aims to leverage the UN/WHO Decade of Healthy Ageing as a unique moment to emphasize the importance of bone health through the healthy aging lens, with a focus on the prevention, treatment and rehabilitation of fragility fractures. Through communications, education, advocacy and cross-discipline collaboration, the BHI is focused on aligning policy change and healthcare practice with 21st-century healthy aging realities to thereby ensure the highest quality of life possible for those with or at risk of osteoporosis and to reduce the costly impact of osteoporosis and fragility fractures on health systems.

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