Closing the ‘osteoporosis care gap’ 

Dr Jason Talevski is developing a care pathway, known as interFRACT, to improve post-fracture care in primary care. 

Osteoporosis is one of the most common musculoskeletal conditions for people over 50 and is associated with a fragility fracture occurring every three seconds around the world. 

A ‘fragility fracture’ is a fracture which results from low energy trauma such as a fall from standing height or less. Despite its common occurrence, recent evidence suggests that very few patients with fragility fractures (20-25 per cent) are diagnosed or treated appropriately for osteoporosis. This is known as the ‘osteoporosis care gap’. 

Fragility fractures can lead to long-term functional impairment, loss of independence, reduced quality of life and premature mortality. Evidence shows that targeted and coordinated treatment following a fragility fracture is effective and can decrease the risk of subsequent fractures. 

Through his Alfred Deakin Postdoctoral Fellowship and supported by the Amgen-Healthy Bones Australia-ANZBMS Clinical Grant Program, Dr Jason Talevski is developing a care pathway, known as interFRACT, to improve post-fracture care in primary care. 

“Currently, established post-fracture care pathways are almost all hospital-based, so they don’t capture a large percentage of fracture patients who present to their family doctor,” Dr Talevski said. 

“GPs are generally the first point of contact for health concerns in Australia and are the most trusted source of health information for most people. They can and should play a critical role in post-fracture management, including promoting strategies for subsequent fracture prevention.” 

Dr Talevski believes a post-fracture care pathway embedded in primary care could guide GPs with evidence-based plans for osteoporosis diagnosis and treatment. It could also help patients engage in fracture prevention strategies such as adherence to osteoporosis medications and uptake of structured exercise plans.  

He is working with consumers and stakeholders to develop the interFRACT pathway to ensure it meets the needs of both patients and health professionals. He has established a Stakeholder Advisory Committee comprising of two GPs, a geriatrician, a fracture liaison nurse, an exercise physiologist and representatives from Musculoskeletal Australia, Healthy Bones Australia, and the Fragility Fracture Network; as well as five consumer representatives.   

He plans to interview GPs to learn about current clinical practices and experiences with osteoporosis and secondary fracture prevention. He will also speak to people who have been diagnosed with osteoporosis or have had a fragility fracture about their perceptions and attitudes towards their treatment and care. 

A series of workshops with the Stakeholder Advisory Committee will develop the components of the interFRACT care pathway based on published evidence and findings from interviews. 

The final stage of the fellowship will be to complete a pilot feasibility study with GPs to help evaluate how acceptable and usable the interFRACT care pathway is in practice.