Osteoporosis and fractures:
secondary prevention through prevention services
Fragility fractures are one of the leading causes of disability and premature mortality in the elderly. It is estimated that the number of such fractures will double by 2050. Osteoporosis is recognized by the WHO as the primary factor contributing to the global disease burden, despite the availability of effective medications that are still underutilized. In fact, less than 20% of individuals who have experienced a fragility fracture receive adequate treatment.
In Italy, fragility fractures affect one in three women and one in five men over the age of fifty. These fractures are associated with a 25% mortality rate within 12 months in the elderly. The increase in the average age of the population contributes to a projected rise in hip fractures. A recent editorial in the New England Journal of Medicine analyzed a diagnostic and therapeutic model aimed at reducing the incidence of secondary fractures.
Professor Nicola Napoli, a member of the SID Board of Directors and the lead author of the study, explains:
“Fracture liaison services (FLS) aim to identify and manage individuals who have sustained a first fracture. This creates a link between the acute event and the long-term management of osteoporosis”.
Service Models
Currently, there are four service models that vary based on the intensity of care provided.
These include patient identification, assessment of fracture risk, fall risk, and nutritional status, with interventions that may include medications, balance and resistance exercises, and nutritional counseling.
Low-intensity approaches involve periodic monitoring of bone health. This multidisciplinary approach has proven to be highly cost-effective, yielding a saving of $10.49 for every dollar invested. Several international scientific societies have emphasized the importance of timely intervention after a first fragility fracture, and countries like Australia and Denmark, which have adopted quality of care indicators, have seen a reduction in mortality.
Similar multidisciplinary care models have been successfully implemented in areas such as diabetes management and heart disease.
Professor Raffaella Buzzetti, President of SID, states:
“The prevention of secondary events is crucial in many diseases and often represents the greatest economic burden on healthcare systems and a deterioration of quality of life for individuals and their families”.
It is therefore essential to adopt specific organizational models for secondary prevention and to monitor medication adherence. Individuals with diabetes, for example, have a significantly higher risk of hip fractures and a much higher rate of complications and mortality compared to non-diabetic patients, making the adoption of this care model vital for frail patients.
Currently, it is estimated that fragility fractures may impact our country’s healthcare expenditure by approximately €10 billion per year, with a growing trend linked to the aging population.
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Fratture da fragilità ossea: colpiscono 1 donna su 3 dopo i 50 anni