The Global Impact of Fragility Fractures and the role of FLS in patient recovery & healthcare systems

Mind the Gap: Unveiling the global impact of fragility fractures and the pivotal role of post-fracture care in patient recovery and healthcare systems.

First, I would like to introduce myself. My name is Jared Torkelson. Since 2016, I have worked as a physician assistant in an orthopedics and sports medicine department.  Soon after, I learned that treating the fracture does not end once the incision is closed. In 2017, I started a fracture liaison service (FLS)/bone optimization clinic within our department to ensure our fracture patients received adequate post-fracture care.  In 2022, I was honored to be voted president of the American Society of Osteoporosis Providers.  We are a group of dedicated practitioners and scientists passionate about osteoporosis and post-fracture care.  We aim to develop an educational certification program for the new and established practitioner so that all care providers treating osteoporosis feel supported and a part of a community to better care for patients.  Over the next year, I challenged myself to write a monthly blog.  My intent with this series is to delve into the crucial aspects of osteoporosis care. These topics may be new to some, and to others, it may be old news.  These posts are intended to provoke thoughts on the current state and how we, as a community, can overcome these challenges.  I am by no means “the expert” at treating osteoporosis and metabolic bone.   Over the past few years, I have been very fortunate to meet some of these “titans” of osteoporosis care and have learned a great deal. I am always open to learning from others, and I hope that you, the reader, will share your stories, opinions, criticisms, and what you have regarding these topics in patient care.  Without further ado… away we go!

When I started to map out these next 12 months, I wanted to look at areas of osteoporosis care and gaps that I had not personally investigated previously.  We have all read many articles in the United States and Western Europe regarding fragility fractures and post-fracture care, but what about the rest of the world?  What is the global burden that undertreating osteoporosis patients is costing?  Mitchel discusses this topic in “The global burden of fragility fractures- What are the differences, and where are the gaps?”.1 The previous article gleans data from a large multinational study that discussed global fracture data.2  In the 2019 study, fractures were looked at for multiple countries regardless of their fracture mechanism.  The data supports the increase in fractures in women starting at age 50. At the same time, men have a bimodal distribution of high fracture rates at ages 15-44 and again starting at age 70.2 The increased fracture rates in the later adult years correlate with the known ages at which fragility fractures tend to occur.  Internationally, since 1990, there has been an increase in new fractures (33.4%), acute or long-term symptoms of fracture (70.1%), and years lived with disability (65.3%).2  Mitchel also discusses the management gaps and economic burdens caused by poor post-fracture care.1  Increasing fragility fractures will post an enormous financial burden on a global scale that will likely end up in billions of dollars.1  Gaps in care management are also appreciated, with delayed time to surgery and inconsistent post-fracture care occurring globally but at a higher rate in low and middle-income countries.2  I will be the first to admit that these facts are unsurprising.  Gravity and hard surfaces are present everywhere…  Appreciating the global impact, understanding that work needs to be done, and bringing awareness are things that, as practitioners, we need to continue ringing the bell for.  Understanding and appreciating that the burden of fragility fractures is not only a burden to the patient but also the global healthcare system.  We must also be aware that the patient continues to deal with the changes in quality of life much after the fracture has healed. 

Can we do more to create awareness at both a national and international level?  What are ideas or areas of communication that have not been utilized to bridge this care gap?  How can we do more?  Ensuring clear, concise communication about the global epidemic is only part of the battle.  We, as practitioners, are not just bystanders. We are the key to treating these patients.  If we cannot prevent the first fracture, we must work hard to stop the second.  We can go fast on our own, but together we can go far. Let's strive for more collaboration and communication among practitioners. Our collective efforts can significantly improve patient care.  Each one of us has a crucial role to play in this mission. It's not just a duty. It's a responsibility we all share. 

Jared Torkelson, PA-C

Physician Assistant

President, The American Society of Osteoporosis Providers

1.       Mitchell, P. J., Chan, D. C., Lee, J. K., Tabu, I., & Alpuerto, B. B. (2022). The global burden of fragility fractures – what are the differences, and where are the gaps? Best Practice & Research Clinical Rheumatology, 36(3), 101777. https://doi.org/10.1016/j.berh.2022.101777

2.       GBD 2019 Fracture Collaborators. (2021). Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019. The Lancet Healthy Longevity, 2(9), e580-e592. https://doi.org/10.1016/S2666-7568(21)00172-0