Intravenous zoledronate reduces refracture risk by a third but the use of this treatment is highly variable.

Members of the Hip Fracture Audit and the Secondary Prevention advisory groups of the Global Fragility Fracture Network have developed a consensus paper regarding the use of zoledronate after hip fracture. This paper provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital.

The aspects discussed are the following:
• Vitamin D status and vitamin D loading regimes
• Renal function and the safety, dose and speed of zoledronate infusions
• Dental issues and extremely low risk of osteonecrosis of the jaw
• Timing of infusion, no need to wait 2 weeks and risk of non-union
• How big a dose of IV Zol is needed?
• How often does IV Zol need to be given?

A Call to Action by the authors!
We invite all those looking after patients with hip fracture to ask not ‘should I give IV Zol?’, but ‘why wouldn’t I give IV Zol?’, and to set up pragmatic local pathways of care to effect this best practice.

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A pilot registry has been established in Greece from September 2022. The project is led by the registry Special Interest Group of the Fragility Fracture Network Greece. Seven different Orthopaedic Departments from six different hospitals (six academic and one state department) nationwide participate in the registry. In each department a local team has been formed for the implementation of the registry locally (data collection, troubleshooting etc).

All teams after obtaining ethical approval from the local ethics committees, collect anonymized data about all fragility hip fractures, who have been admitted in their departments prospectively. For this purpose the 22 points of Minimum Common Data Set, proposed by the Global Fragility Fracture Network, with the addition of the 30 day mortality, is used.

The Greek Fragility Hip Fracture Registry is now functional for 18 months. The data of the first one year of the registry (01-09-22 to 31-08-23) have been analyzed. A total of 822 patients with a fragility hip fracture admitted in the involved orthopaedic departments have been included so far. The majority of the patients were female (70,9%) at a mean age of 81.24 ± 10.5 years.

The use of a national hip fracture registry has been proven a valuable tool in the evaluation and improvement of national health care services across the globe. So far, the present pilot registry proves that the establishment of a national fragility hip fracture registry in Greece is feasible and demonstrates that the minimum common data set can be used as the base of any new registry.

Professor Antony Johansen conducted the external evaluation of the 18th month report in February 2024. Based on this initiative, a fracture liaison service (FLS) has now been launched in Greece, using the data collected from the registry.

Vertebral Fragility Fractures (VFF) are the most common fractures that occur due to osteoporosis, and are associated with pain and disability. Given that vertebral fractures often occur due to falls or certain types of movements, physiotherapy may be an important part of the  clinical management of VFF patients. There are several interventions that physiotherapists might use to manage spine fractures, such as bracing, taping, education, and exercise. This scoping review was conducted to generate an overview of the literature regarding physiotherapy interventions post VFF. 

Thirteen studies were included in this review, with number of  participants ranging from 20 to 613 (mean age 71.9), all with a history of VFF.
• Exercise was the most frequently reported intervention with a mix of strength (trunk or general), balance and postural training and with exercise often acting as an element of a multi modal intervention, alongside manual therapy or education.
• Education was a commonly delivered intervention but without reported measurement of participant knowledge, beliefs, or behaviours.
• The description of the exercise programmes lacked specifics regarding training volume and programme parameters.

According to the authors: Large scale, high quality research with representative samples, clearly documented physiotherapy interventions and agreed core outcomes is required to inform clinical guidelines for the management of VFF in both the acute and late rehabilitation phases

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A working group of the Fragility Fracture Network Hip Fracture Audit Special Interest Group has developed recommendations on the management of hip fracture patients who are taking direct oral anticoagulants. The treatment of these patients is inconsistent around the world related to concerns about complications. 

Following a review of the literature and a consensus process the following four consensus statements were achieved:  

These statements will help clinicians make the decision on timely management for this vulnerable patient population.   

Click here for the infographic with the consensus statements.

Click here for the article.

This study included 551 patients with fragility fracture (346 before and 205 after FLS implementation) and aimed at evaluating the impact of the implementation of a Portuguese FLS on Osteoporosis treatment, secondary fracture, and mortality rates three years after a fragility fracture. 

The FLS protocol was based on the cooperation between Orthopaedic/Traumatology Department (Identification of patients at Risk) and Rheumatology Department (OP assessment, Subsequent treatment by Physiatrist and Rheumatologist). Secondary fragility fractures, hospitalizations, and mortality were assessed 36 months from the date of the index fracture. 

According to the authors of the study: ‘We believe that our work supports the establishment of national programs with the adoption of the FLS model, which could lead to better Osteoporosis outcomes regarding fractures and mortality, and promote quality of life’. 

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