Bone health

Secondary fracture prevention: time to break the status quo

A national alliance of more than 30 health, medical, patient and consumer organisations has come together to take responsibility for improving the management of osteoporotic fractures in Australia.

Endocrinologist Professor Markus Seibel, chair of the national steering committee for SOS Fracture Alliance, told the limbic there were medical, ethical and financial drivers for change.

“Four out of five people with an osteoporotic fracture are denied appropriate investigations and management to identify and treat their osteoporosis,” he said.

“Imagine someone with heart disease gets a stent but no follow-up treatment with beta-blockers; or a women with breast cancer has surgery but no follow-up with chemotherapy or radiotherapy.”

“So people are re-presenting with a third, fourth or fifth fracture. This isn’t about age; this is a treatable disease.”

He said osteoporosis did not have the ‘prestige’ value of cancer or heart disease but things were about to change.

“We have all the medical colleges on board, research institutes and a representative cross-section of the community with organisations such as the Country Women’s Association of Australia and Carers Australia.”

“We cannot allow doctors to deny patients management for a serious condition that is associated with such morbidity and mortality.”

Professor Siebel said the immediate priority was to develop sustainable models of secondary fracture prevention and pilot them in primary health networks (PHNs).

“The UK has done very well with this including through incentivising doctors in their health districts.”

He said Australia had about 25 secondary fracture prevention programs – mostly arising from local ‘champions’ but with no systemic approach.

“A hip fracture costs about $30,000-40,000. Preventing one costs about 10% of that,” he said. “It is not good enough to rely on the goodwill of certain clinicians.”

He said osteoporosis was a federal responsibility with most of the disease managed in primary care.

“Vertebral fractures for example don’t show up in hospitals. They are the most common fracture and increase the risk of a subsequent fracture ten-fold.”

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