ASBMR task force urges use of fracture liaision services to reduce costly osteoporosis bone breaks

An international expert task force is calling on health care providers to aggressively identify and provide care for the millions of people who have suffered their first osteoporosis-related fracture, in order to prevent subsequent fractures. In an extensive review of possible solutions to prevent these so-called "secondary fractures," the task force identified the most effective solution – a system of patient care coordination called "fracture liaison services" that research has shown to significantly improve follow-up assessment and treatment after an initial fracture occurs, thereby reducing the likelihood of additional bone breaks. The most significant barrier to widespread use of the model is the lack of insurance coverage, according to the task force report which appears online in the Journal of Bone and Mineral Research.

The task force, convened by the American Society for Bone and Mineral Research, is urging health care providers to routinely provide osteoporosis testing and initiate treatment with medication as needed for all men and women over the age of 50 who have suffered a fracture. One major goal is a 20 percent reduction in hip fractures by 2020, when the United States and other countries around the world are expected to be hit with a wave of fractures because of an aging population.

"Fractures beget fractures and lead to untold suffering. Our task force looked at ways to break this vicious cycle," said Ethel S. Siris, M.D., co-chair of the task force. "We learned what works and what doesn't. The research is clear: fracture liaison services are saving suffering, and they are saving money."

Hip fractures are often the most serious type of bone break and the most expensive to treat. Each year nearly 300,000 older adults in the U.S. suffer hip fractures and more than 20 percent die within a year of their injury. Fracture liaison service programs such as the Kaiser Permanente "Healthy Bones" model of care have been shown to reduce hip fractures by almost 40 percent. If implemented nationally, this model of care could save nearly $3 billion per year, according a recent study authored by one task force member.

"The increasing incidence of osteoporosis-related fractures is a public health disaster – one that already causes untold suffering and is slated to add $25 billion to the nation's health care costs by 2025," said Siris, an osteoporosis expert at the College of Physicians and Surgeons of Columbia University in New York. "We know that once a first fracture occurs the risk of additional fractures is high. Targeting these individuals for treatment to reduce the possibility of more fractures will save a lot of human suffering and tremendous expense to the health care budget."

Siris says emergency room physicians and orthopedic surgeons do an excellent job fixing that first fracture but there is currently a profound lack of connection between the "fracture fixer and the fracture preventer" who needs to provide medical treatment for osteoporosis. Fracture liaison service coordinators serve the critical role of bridging that gap, educating the patient, getting the patient seen for medical management and following up to assure that the patient is taking the needed medications to prevent future fractures.

In the most comprehensive review of the research on secondary fracture prevention conducted to date, the task force report outlines the evidence supporting widespread implementation of and insurance coverage for fracture liaison services after a patient over age 50 experiences a bone fracture. Currently however, insurers rarely pay for coordination of care related to the services of a fracture liaison service coordinator who arranges for follow up care.

These secondary fractures, often caused by undiagnosed or untreated osteoporosis, are a growing public health crisis of an aging population. The service concept is not only effective, according to the task force, but reduces health costs. Fracture liaison service coordinators are relatively inexpensive and studies show that the cost of paying for such care is a sound investment – one that effectively prevents fractures and saves money, the task force said.

"This report is a health delivery breakthrough even if it is not a clinical breakthrough, and it will definitely benefit patients if implemented," said Keith Hruska, M.D., ASBMR president. "With the increasing attention paid these days on cutting costs in health systems, this research is a great example of comparative effectiveness research. We have a road map for what treatment systems are the most effective for osteoporosis patients and most cost effective as well."

Although several initiatives in the United States and internationally are pushing for coordinating the groups that treat and manage fractures, the task force suggests that a cooperative approach by these groups could magnify the effort to get solutions in place. In order to speed up progress on this front, the task force also recommends a central clearing house, one that could identify best practices and help providers and others overcome the obstacles to the prevention of fractures.