We are excited to announce the launch of FFN Portugal which occurred on November 27, 2023.

FFN Portugal is being led by the incoming president António Miranda, who is an Orthopaedic Surgeon.

As per the mandate of FFN, the leadership team is multidisciplinary, consisting of 16 members from 13 different areas of interest who are involved in the treatment of patients with fragility fractures. 

FFN Portugal have set a series of ambitious goals for the next 2 years 
- Development of the FFN Portugal communication strategy to engage and inform health care professionals across Portugal including a website, presence on social media and in the press

- Translation of FFN's manuals and publications to increase the resources available on best practice

- Increasing their national presence to increase knowledge uptake including attracting new members, involving institutions, policymakers, and stakeholders

- Creation of the National Registry of Hip Fractures, based on the FFN's Minimum Common Dataset 2022 and Hip Fracture Registry Toolbox

Dr Bruno Carvalho, Vice President of FFN Portugal, notes that "FFN Portugal is very proud of our team and excited about the potential that this initiative has to improve the care of patients with fragility fractures in Portugal."

At FFN global we look forward to continuing to work with Portugal as they grow their initiatives over the next few years.

Our congratulations to the FFN Portugal members for all their hard work!

Learn more about FFN Portugal here.

Αn advanced physiotherapist model in hip fracture care may reduce costs and surgical registrar time without adversely influencing patient outcomes.

Advance physiotherapy roles in elective arthroplasty across global settings have demonstrated benefit in safely reducing time burden on surgical teams and healthcare costs. The utility of similar roles in the care of hip fracture is unclear. This quality initiative, conducted in Australia, aimed to implement and evaluate a new model of care substituting a surgical registrar with an advanced physiotherapist in a post-discharge hip fracture clinic.

During the implementation of this model (October 2020- January 2023), 346 hip fracture patients (median age 75 years) were seen by an advanced physiotherapist. The following key elements were reported:

• Eighty-one patients seen by an advanced physiotherapist required brief informal discussion with the consultant surgeon during physiotherapy management sessions.
• Fifteen patients required a formal consultant review and ongoing management by the surgeon; these were routinely patients with complex pain management or requiring surgical revision. 
• There have been no patient complaints, critical incidents or other unintended consequences following implementation.
• The overall net surgical time realised over the 3 years was 110 hours. While there were no physiotherapy overtime hours, 5347 hours of registrar surgical overtime were incurred during the evaluation period.
• Cost comparative data suggest a very small cost of $A330 across the entirety of the programme, although basic modelling did not account for the reduction in surgical penalty rates for overtime. 

The study demonstrated that this model in hip fracture care is cost neutral, may reduce overtime and associated penalty payments, and free up surgical registrar time for full scope surgical tasks, without adversely influencing patient satisfaction or leading to harm.

The authors concluded that: ‘This single site quality initiative provides a passing glance at the potential benefit of an advanced physiotherapy clinic for hip fracture patients. We are looking forward to ongoing research to rigorously evaluate this innovative approach to meeting the foreseen challenge of unmet surgical demand for service in this vulnerable population’.

Click here to read the article!

The management of Vertebral Fragility Fractures (VFF) is a problem around the globe. Models have been developed to highlight best practice care for individuals who have had a VFF. It is unclear if these models are appropriate and realistic in high, low- and middle-income countries or if new tools would help clinicians manage these complex patients through their acute episode, their recovery or secondary prevention.  

To find out more about what is happening around the globe, through the VFF Special Interest Group, FFN clinical experts have adapted, with permission, the Royal Osteoporosis Society (UK) Model which reflects the best evidence currently available.  

They are now undertaking a survey to identify if this model is appropriate and realistic for providing care in different healthcare sectors (hospitals and primary care) and countries. The survey results will also provide information on tools that could be developed to help healthcare professionals improve their care.

The survey can be completed by any healthcare professional who has seen one or more VFF patients in 2023, through any stage of their acute episode to recovery, return to function, and secondary prevention. 

If you treat VFF patients, please help us to find out about VFF across the globe by accessing the 10-minute survey here.

Please share this with your colleagues who are interested in VFF.

For any questions, please contact Operations@fragilityfracturenetwork.org

The integrated orthogeriatric care model with shared responsibility and decision-making between the orthopaedic surgeon and the geriatrician has a positive effect on quality indicators pre-and post-operatively for hip fracture patients.

Orthogeriatric care improves the hip fracture patient’s opportunity to attain prefracture level of mobility, independency and health, but there is no consensus on which model of orthogeriatric care that is best to achieve patients prefracture function. The aim of this study was to evaluate two different orthogeriatric models for patients with hip fracture. The study was conducted at Oslo University hospital in Norway and included 516 patients >65 with a hip fracture.

An ‘Integrated Care Model’ (ICM) was compared with a ‘Geriatric Consult Service’ (GCS). The differences between the care protocols of these models were that in ICM there was an evening round by the geriatrician on call preoperatively and the ICM group followed the routine in the orthogeriatric unit, where every day the orthogeriatric team (geriatrician, orthopaedic surgeon, hip fracture nurse and physiotherapist) participated at interdisciplinary rounds to the patients. The patients in the GCS group followed the routine in the orthopaedic trauma ward with rounds by the orthopaedic surgeon and nurse. In addition, they were offered a visit by the geriatrician but without the orthogeriatric team.

The results of the study indicated that the ICM with co-management of the patients and shared decision-making and responsibility between the orthopaedic surgeon and the geriatrician, provided equally good or better results on all the quality indicators measured.  The quality indicators regarding postoperative care (removal of urinary catheter 1 postoperative day, mobilisation 1 postoperative day and treatment with antiosteoporotic drugs) has the highest level of improvement at the ICM model, in addition to preoperative nerve block. There was no statistically significant difference between the 2 models in terms of mortality.

Dr Lene Solberg, one of the authors, stated: ‘ICM provides better acute care for the hip fracture patients measured by selected quality indicators. However, more research which embraces a wider spectrum is needed to clearly state that a model of co-management between the orthopaedics and the geriatricians affects important outcome measures, such as mobility, post-discharge dependency and quality of life.’ 

Click here to read the article!

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.'

Click here to read the article!

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.

Click here to read the article!

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.

Read the article here!

Perioperative interventions, such as analgesia regimens, timing of surgery and type of anaesthesia, are recommended in clinical practice guidelines to address barriers to early mobilisation and optimise physical function outcomes. 

The aim of this systematic review and meta-analysis was to determine the effectiveness of perioperative interventions on achieving early mobilisation and improving physical function after hip fracture.

Twenty-eight studies were included in this systematic review and meta-analysis, in which participated a total of 8,192 patients with a fractured proximal femur and a mean age of 80 years. Interventions were grouped into six categories: analgesia, pathways and models of care, rehabilitation delivery modes, surgical protocols, nutritional supplements and clinical supervision.

The results of this study indicated that:

The authors concluded that many barriers to early mobilisation are potential amenable to perioperative interventions. The delivery of these perioperative interventions varies substantially between hospital sites and their impact on the ability to mobilise early postoperatively and restoration of physical function is not yet well understood. Future aetiologic studies are required to understand and model the causal mechanisms by which early mobilisation and physical function after hip fracture can be improved by perioperative interventions.

Click here for the article!

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