Preventing fragility fractures

Osteoporosis is a common condition that many New Zealanders might not be familiar with, but its impact is widely felt, especially among adults 50 years and older.

This chronic condition weakens bones, making them brittle and more susceptible to fractures from minor falls or bumps, known as fragility fractures.

Osteoporosis New Zealand (ONZ) estimates that 22,300 fragility fractures occur annually in New Zealand, including almost 4,000 hip fractures. This has a significant impact not only on those who sustain these fractures and their families and whānau, but also the healthcare system.

The total annual number of hospital bed days attributable to fragility fractures is equivalent to a 525-bed hospital being occupied every day of the year with someone recovering from a fragility fracture.

A comprehensive national programme is well underway to tackle this issue.

The Fracture Liaison Services (FLS) offer a coordinated approach that aims to deliver world-class care to people who sustain a fragility fracture.

This service is crucial because half of the people who suffer a hip fracture have previously broken another bone, which should have triggered a fracture risk assessment and preventive measures. But in the absence of FLS, frequently does not.

ACC supports the funding of FLS as part of the Live Stronger for Longer programme.

“The goal of an FLS is to prevent future fractures by ensuring patients receive appropriate, timely diagnosis, treatment, and follow-up care,” says James Whitaker, ACC Injury Prevention Programme Lead.

Over the past decade, there has been a progressive expansion of FLS across New Zealand. By mid2024, each Health NZ region will have an FLS, thanks to the strategic partnership between ONZ and ACC.

These services are primarily based in hospital settings but rely on close coordination with primary care providers to deliver comprehensive long-term care. This includes patient assessment, initiation and continuation of treatment, and implementation of falls prevention strategies.

In 2023, ACC accepted over 173,000 new claims for fall-related injuries among adults over 65 years of age, costing $345 million. Without preventive measures, these costs are projected to soar to $720 million by 2035.

New Zealand’s FLS are genuinely world-class, as demonstrated by the fact that the majority of them feature on the International Osteoporosis Foundation’s Capture the Fracture Map of Best Practice.

The FLS create care plans and provide treatment recommendations to suit individual needs.

By focusing on future falls and fracture prevention, personalised treatment, and continuous care, FLS help individuals maintain stronger bones. This leads to a higher quality of life.

Someone who has already suffered a fragility fracture almost doubles their risk of further fractures. This is something FLS hopes to change, as FLS models are proven to be the most cost-effective way of preventing secondary fractures.

Whitaker says public education around secondary fracture prevention is vital in reducing the number of fragility fractures across Aotearoa.

“If you think you might benefit from an FLS, speak with your healthcare provider about the options available to you in your district,” says Whitaker.

“Also, if you are surprised that you have a fracture after a seemingly minor incident it would be worth asking to have your bone density assessed. Taking these steps could help you to avoid other issues in the future.”

Transforming bone health with Fracture Liaison Services

• Why FLS are needed: Fracture Liaison Services are vital for New Zealand because they close the care gap for people over 50 years of age who sustain fragility fractures, preventing future fractures and improving the quality of life for older adults.
• How FLS work: FLS are organised in all Health NZ regions with support from ACC, ONZ and coordination with primary care providers. They ensure patients receive comprehensive care, including diagnosis, treatment, and falls prevention, benchmarked against national clinical standards informed by international best practices.
• What benefits FLS deliver: FLS achieve significant improvements in clinical care quality and outcomes for individuals aged 50 years and over who suffer an initial fragility fracture. They help reduce the risk of subsequent fractures, thereby lowering healthcare costs, enhancing the wellbeing of older New Zealanders, and freeing up thousands of hospital beds annually so that other serious conditions can be treated without delay.