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Scientific Review
Media Articles
Welcome to Fragility.Org - A website devoted to Osteoporotic Fracture Treatment
Written by Web Master
Thursday, 12 June 2003
The Osteoporotic Fracture Campaign (OFC) is a major initiative of the International Society for Fracture Repair (ISFR - www.fractures.com).
The campaign was initiated at the ISFR Symposium on "Osteoporotic Fracture Healing" at the Rizzoli Institute, Bologna, Italy, 2002. It is unique because it focuses on the surgical treatment which has been neglected in other similar osteoporosis campaigns.
The increasing demand on orthopaedic surgeons to deal with osteoporotic fractures due to an increasing incidence in the community requires the development of new strategies and more effective solutions.
This campaign seeks to form partnerships with leading clinicians, policymakers, and industry to increase awareness and promote research and service development.
Our activities include regular newsletters, discussion groups, meetings, conferences, symposia, workshops and research collaboration.
We would welcome support from Individuals or Organisations involved in the science, clinical care, economics, societal impact or media coverage of issues relating to osteoporotic fracture treatment.
The Osteoporotic Fracture Campaign : Changing the Outlook for Fragility-Fracture Patients
Lisa Strickland
Thousands of fractures occur every year as a result of osteoporosis. The morbidity and indirect mortality rates associated with this disease are high, causing osteoporosis to be a major public health concern. The International Society for Fracture Repair has launched an aggressive campaign to improve the treatment of fragility fractures. This campaign seeks to form partnerships with leading clinicians, policymakers, and industry to increase awareness and promote research and service development. Workshops to further define the research agenda have been scheduled, and efforts to expand the existing database of partners are underway. With innovative thinking and collaborative action, the quality of life for osteoporosis patients can be improved. Adv Osteoporotic Fract Manag 2003;2(3):88–9.
Skeletal homeostasis in a young, healthy individual is maintained by an interplay of bone formation relative to bone resorption. Increasing age, as well as genetic, environmental, and hormonal factors can disrupt this process, causing an acceleration of bone loss and an increased risk for fracture.
Characterized by decreased bone mass and alterations in the micro-architectural integrity of the skeleton, osteoporosis is a disease that is not exclusive to populations of particular age or gender, although most cases tend to occur in postmenopausal or elderly women.
Once begun, osteoporosis is irreversible. The disease usually progresses without symptoms, and is frequently undetected until the first fracture occurs. With treatment, the process can be slowed; however, the poor quality of life following a fragility fracture remains a considerable public health concern.
One in two women and one in four men >50 years old will sustain an osteoporotic fracture in their lifetime [1]. By the year 2050, the number of osteoporotic fractures worldwide is expected to increase threefold, with a marked demographic shift in incidence from developed to less-developed countries [2–5].
Despite laudable initiatives aimed at primary prevention and increased awareness, the vast majority of patients hospitalized with a fragility fracture are neither evaluated nor treated for osteoporosis [6]. Attention has been focused on primary prevention via treatment before the first fracture, therefore, the inevitable rise in fracture incidence due to the aging population and the surgical management of this disease have been given insufficient priority by osteoporosis organizations and public health policy alike.
From a surgical standpoint, a prime opportunity for the diagnosis and management of osteoporosis exists whenever a patient presents with a fragility fracture. However, studies have shown that confirmation of the disease based on bone mineral density measurement, assessment of fracture risk, and development of case-specific treatment plans is not standard practice [7].
The International Society for Fracture Repair (ISFR) is an organization of scientists and surgeons dedicated to advancing the science of fracture treatment. During a round table discussion at the 2002 ISFR symposium 'Fracture Treatment in Elderly and Osteoporotic Patients', Antonio Moroni (Rizzoli Orthopedic Institute, Bologna, Italy) put forth a motion to improve treatment methods, standardize treatment protocols, and increase research funding for osteoporotic fracture patients. The Osteoporotic Fracture Campaign (OFC) was formally adopted by the ISFR General Assembly in October 2002, and is managed by a five-member ISFR Steering Group.
Partnership for change
The OFC is the global banner under which medical societies, industry, and policymakers work in partnership to develop and coordinate campaign-related initiatives. Research and development of new fracture fixation techniques, systems for targeting secondary prevention, and increased government prioritization are cornerstones of the agenda.
The burden fragility fractures place on healthcare systems and society is expected to worsen. A shift in emphasis — from primary prevention to a viewpoint that encompasses secondary prevention — must occur. The OFC mission is to support and contribute to primary prevention efforts, but with the understanding that the balance needs to be redressed with respect to the fracture aspects of the underlying disease.
Among the many surgical concerns associated with the treatment of fragility fractures, fixation failure is one of the greatest. Fixation hardware often fails to adequately grip porous bone, thus contributing to the high failure rates and comorbidity found in this patient group.
Research into bioactive materials and the development of implants and fixation devices designed specifically for use in osteoporotic bone has great potential for industry, and is fundamental to elevating the standard of care for this vulnerable patient population. When viewed in light of the epidemiological forecast for osteoporotic fracture incidence over the next few decades, the benefits of campaign-fostered scientific and industrial collaboration are clear.
In Europe, national policies concerning the treatment of osteoporosis vary greatly. Undoubtedly, this disparity has contributed to a less than comprehensive assessment of the incidence of osteoporosis in Europe, and continues to be a stumbling block in terms of risk assessment and management of the disease.
At present, Europe lacks a defined framework into which collected data can be placed and evaluated. In addition, the data must be of sufficient quantity and quality to warrant application of the results into clinical practice. Without large-scale data, proposals for secondary prevention programs, such as multidisciplinary patient care networks, have little chance of capturing the attention of policymakers.
To assist in the evaluation of osteoporosis programs and plan future resource allocation, the OFC is participating in a European Union fragility-fracture database working group. In cooperation with the International Osteoporosis Foundation and the European Commission, viable methods for obtaining and tracking individual patient outcomes, as well as the number and cost of fragility fractures, are currently under discussion.
One of the more important campaign activities will be a series of workshops. By providing an ideal forum for international discussion and problem resolution, such workshops can raise awareness of the challenges faced in many parts of the world, as well as define the service development and resource agendas needed to take the campaign forward. The first OFC workshop is scheduled to take place in New York, USA in the autumn of this year. In addition, the ISFR is planning satellite workshops to be held in conjunction with annual major orthopedic and trauma society meetings.
Partnership network
At the annual American Academy of Orthopedic Surgeons meeting in February this year, the OFC campaign was introduced to an international audience of surgeons and industry personnel. Attendees were invited to join the network and encouraged to add surgical issues to the prevention movement in their respective countries. As the campaign's greatest strength lies in partnership, the immediate task concerns expansion of the network via the OFC database. Partners will be able to track campaign-related developments and foster alliances with others within the network; surgeons and industry can use the database as a source of referral when designing clinical trials. In short, the database will raise awareness, facilitate communication between the various factions, and is invaluable in terms of extending the reach of the campaign.
Conclusion
Discussion of strategies for the management of this disease must continue if we are to improve the quality of life for fragility fracture patients. Current osteoporosis programs should be evaluated in terms of their positive impact on disease management and the secondary prevention programs incorporated into clinical practice. Surgeons, industry, and policymakers must work together to diminish the suffering and economic burden these fractures cause.
References
- Statistics obtained from Fast Facts on Osteoporosis, National Osteoporosis Foundation Disease Statistics 2003. www.nof.org
- Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: A worldwide projection. Osteoporosis Int 1992;2:285–9.
- Johnell O, Obrant KJ. What is the impact of osteoporosis? Baillieres Clin Rheumatol 1997;(3):459–77.
- Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: Insights afforded by epidemiology. Bone 1995;17:505–11S.
- Lau EM. Osteoporosis — a worldwide problem and the implications in Asia. Ann Acad Med Singapore 2002;31:67–8.
- Freedman KB, Kaplan FS, Bilker WB et al. Treatment of osteoporosis: Are physicians missing an opportunity? J Bone Joint Surg Am 2000;82-a:1063–70.
- Freedman KB. Osteoporosis prevention and the orthopaedic surgeon: When fracture care is not enough. J Bone Joint Surg Am 1999;81:1652–3.
Last Updated ( Sunday, 03 April 2005 )
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