Fracture Unit: a model of continuity of treatment in fragility fractures

Abstract

Fragility fractures result from a progressive depletion of bone tissue, mainly caused by aging and the menopause. Due to the increased aging population, fragility fractures are currently placing a considerable economic burden on national health systems. Despite the present awareness regarding osteoporotic fractures, many patients are not yet appropriately treated or do not carry out the treatment on a continuous basis. As a result, osteoporosis remains an undertreated and underdiagnosed pathology that increases the patient’s fracture risk 2-3 fold. Fracture Units (FUs) are tertiary prevention models whose main aim is to direct patients to programs to avoid subsequent fractures. FUs address patients who have suffered a fragility fracture through a complete multidisciplinary diagnostic approach thatis started at hospital admission and should be followed by regular check-ups after discharge: long-term personalized therapeutic programs are tailored to each patient’s intrinsic fracture risk and comorbidities. FUs make use of local hospital-based resources with nurses playing a decisive role as intermediary figures between doctors and patients, taking care of the latter at follow-ups.The potential benefits of FUs include: (1) reduction of present fracture complications, (2) reduction of subsequent fracture risk by promoting diagnostic tests (e.g. DXA scans or spinal X-rays), (3) greater percentages of patients discharged with optimal anti-osteoporosis therapy, and (4) reduction of healthcare costs associated with osteoporosis. The main goal of this review is to illustrate and describe economic and clinical outcomes using the FU model of care with reference to other, different types of service models.