Fragility fractures – a global cause for concern
Matt Costa, Professor of Orthopaedic Trauma at the University of Oxford and President elect of the Fragility Fracture Network (FFN), explains the need for global action to provide better care for people suffering from hip fractures and other fractures that result from increased fragility.
The global population is currently undergoing the greatest demographic shift in the history of humankind. A direct consequence of this "longevity miracle" – if left unchecked – will be an explosion in the incidence of chronic diseases afflicting older people.
A new Global Call to Action for better care for people suffering from hip fractures and other fractures that result from increased fragility illustrates that for the first time, the leading organisations in the world have recognised the need for collaboration on an entirely new scale.
The UK has recognised the need for multi-disciplinary care for patients with fragility fracture and has the world's largest national hip fracture database (NHFD). These are essential parts of our response to the coming fragility fracture crisis, but we need to do more. Here in Oxford, we will use the World Hip Trauma Evaluation (WHiTE) research project to collect research data from around the world to improve quality of life for patients everywhere.
In the absence of systematic and system-wide interventions, this tsunami of need is poised to engulf health and social care systems throughout the world. Osteoporosis, falls and the fragility fractures that follow will be at the vanguard of this battle which is set to rage between quantity and quality of life.
By 2010, the global incidence of one of the most common and debilitating fragility fractures, hip fracture, was estimated to be 2.7 million cases per year. Conservative projections suggest that this will increase to 4.5 million cases per year by 2050. While all countries will be impacted, in absolute terms, Asia will bear the brunt of this growing burden of disease, with around half of hip fractures occurring in this region by the middle of the century. And the associated costs are staggering: in Europe in 2010, osteoporosis cost Euro 37 billion, while in the United States estimates for fracture costs for 2020 are US$22 billion.
If our health and social care systems are to withstand this assault, a robust strategy must be devised, and an army of health professionals amassed to deliver it. This strategy must transform how we currently treat and rehabilitate people who have sustained fragility fractures, in combination with preventing as many fractures from occurring as possible. The latter can be achieved in part by ensuring that health systems always respond to the first fracture to prevent second and subsequent fractures. In short, let the first fracture be the last.
A major step towards making this aspiration a reality has occurred today with publication of a Global Call to Action to improve the care of people with fragility fractures. Endorsed by 80 leading organisations from around the world, covering the fields of medicine and nursing for older people, orthopaedic surgery, osteoporosis and metabolic bone disease, physiotherapy, rehabilitation medicine and rheumatology, the case for transformation of the following aspects of care has been made:
- The surgical and medical care provided to a person hospitalised with a hip fracture, a painful fracture of the spine and other major fragility fractures.
- Prevention of second and subsequent fractures for people who have sustained their first fragility fracture.
- Rehabilitation of people whose ability to function is impaired by hip fractures and other major fragility fractures, to restore their mobility and independence.
The Call to Action was conceived at an annual congress of the FFN, when six leading organisations came together to determine how they could most effectively collaborate to improve fracture care globally. The lead author of the publication, Professor Karsten E. Dreinhöfer said 'Fragility fractures can devastate the quality of life of people who suffer them and are pushing our already overstretched health systems to breaking point.' He added 'as the first of the baby boomers are now into their seventies, we must take control of this problem immediately before it is too late.'
The Global Call to Action proposes specific priorities for people with fragility fractures and their advocacy organisations, individual health workers, healthcare professional organisations, governmental organisations and nations as such, insurers, health systems and healthcare practices, and the life sciences industry. The World Health Organisation (WHO) has declared the years 2020-2030 to be the "Decade of Healthy Aging" and later this year the United Nations (UN) will hold its Third High-level Meeting on Non-Communicable Diseases. The authors highlight the opportunity for WHO and UN to consider the recommendations made in the Global Call to Action as an enabler for their global initiatives.