Preventing the next fragility fracture: An International Survey of the FFN Secondary Fracture Prevention Special Interest Group 

Preventing the next fragility fracture: An International Survey of the FFN Secondary Fracture Prevention Special Interest Group 

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:

  • The need to expand the reach of SFFPS to include more fragility fracture patients, as 25% of SFFPS reported that they limited their reach to patients with hip fracture.
  • Improve the collection and reporting of patient outcome measures, patient reported outcomes and KPIs or quality indicators. Less than 50% of SFFPS used a data system to record patient outcomes and less than 40% reported KPIs or quality indicators to their healthcare organizations.
  • The need to develop core educational competencies for all providers within SFFPS, as very few SFFPS had mandatory training in key areas that are needed for a high-functioning SFFPS: including: comprehensive management strategies for refracture prevention, bone mineral density interpretation, behavior change and quality improvement.

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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