Primary care physician education toolkit may help reduce burden of secondary osteoporosis fractures

A comprehensive toolkit tailored to arming primary care physicians (PCPs) with practical resources to help them identify, assess, and manage those at risk of fractures has recently been launched by the Asia Pacific Fragility Fracture Alliance (APFFA).

The APFFA PCP Education Toolkit contains materials and templates to enable the planning and execution of two, hour-long, PCP workshops which will highlight the growing burden of fractures, identify patients at high risk of fracture, and reinforce the importance of secondary fracture prevention. With the launch of the toolkit, the alliance hopes to see improvement in the safety and quality of patient care among those at risk.

According to past president of the International Society of Clinical Densitometry and APFFA Education Working Group Chair, Professor Robert Blank, of Sydney, Australia, the PCP Education Toolkit recognizes the critical role PCPs have in reducing the burden of osteoporotic fractures, which have a huge impact on survival, function and quality of life, by acting promptly and appropriately after the first fracture.

Blank said: “Due to the ubiquity of osteoporosis, PCPs are uniquely placed to identify and manage patients at risk of fractures. There are too many patients for all to be managed by specialists, even in well-resourced countries. Primary care therefore plays a critical role in preventing the health burden associated with osteoporosis, with the majority of medicines for osteoporosis initiated by PCPs.”

He added that while those who sustain minimal trauma fractures may not always go to a hospital, almost all will eventually see their PCP, placing the PCP in a unique position to ensure patients are appropriately managed post-fracture. “Currently, a concerning 70 to 85 percent of patients presenting to their PCP or hospital with a minimal trauma fracture, are neither assessed for osteoporosis, nor appropriately managed, to prevent further fractures.” [Available at https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/osteoporosis Accessed on 28 September]

Worldwide, older people represent the fastest growing demographic thus translating to a rise in annual fractures with this trajectory of growth. Dato’ Dr Lee Joon-Kiong, an orthopaedic surgeon in Malaysia and APFFA co-chair, noted that even if age-adjusted incidence rates for hip fracture remain stable, the estimated number of hip fractures worldwide will rise from 1.7 million in 1990 to 6.3 million in 2050. [Lancet 2006;367(9527):2010–2018]

Lee added: “Disturbingly, despite the presence of generally safe and effective treatments, only a minority of low trauma fracture patients are evaluated and treated for underlying osteoporosis. In fact, the vast majority of older adults who sustain fractures do not receive subsequent interventions to identify and treat underlying, modifiable fracture risk factors.”

Another APFFA co-chair, Professor Derrick Chan, of Taiwan, said the toolkit materials emphasize how fractures in older adults compromise mobility, independence and quality of life. Furthermore, the toolkit reinforces that the incidence of a fracture is enough to diagnose osteoporosis, regardless of a patient’s bone mineral density (BMD).

Chan, a gerontologist and geriatrician, said: “Less than a third of hip fracture patients regain their pre-fracture level of mobility, while more than 80 percent are restricted with their daily activities, such as driving or grocery shopping.” [Med J Aust 2013;199(S7):S1–S46, Am J Med 1997;103(2A):12S–17S]

To make matters worse, an initial fracture raises the risk of subsequent fractures and more than 30 percent of all subsequent fractures occur within the first year of an initial fracture of the spine, shoulder or hip, noted Chan. “Even with improvements in medical management, fracture patients continue to experience lower health-related quality of life. Those who have sustained fractures in more than one location, particularly of the spine, hip and upper leg, have a significantly compromised quality of life.”