Experience of a systematic approach to care and prevention of fragility fractures in New Zealand

Christine Ellen Gill; Paul James Mitchell; Jan Clark; Jillian Cornish; Peter Fergusson; Nigel Gilchrist; Lynne Hayman; Sue Hornblow; David Kim; Denise Mackenzie; Stella Milsom; Adrienne von Tunzelmann; Elizabeth Binns; Kim Fergusson; Stewart Fleming; Sarah Hurring; Rebbecca Lilley; Caroline Miller; Pierre Navarre; Andrea Pettett; Shankar Sankaran; Min Yee Seow; Jenny Sincock; Nicola Ward; Mark Wright; Jacqueline Clare Therese Close; Ian Andrew Harris; Elizabeth Armstrong; Jamie Hallen; Joanna Hikaka; Ngaire Kerse; Andrea Vujnovich; Kirtan Ganda; Markus Joachim Seibel; Thomas Jackson; Paul Kennedy; Kirsten Malpas; Leona Dann; Carl Shuker; Colleen Dunne; Philip Wood; Jay Magaziner; David Marsh; Irewin Tabu; Cyrus Cooper; Philippe Halbout; Muhammad Kassim Javaid; Kristina Åkesson; Anastasia Soulié Mlotek; Eric Brûlé-Champagne; Roger Harris

doi:10.1007/s11657-022-01138-1

Experience of a systematic approach to care and prevention of fragility fractures in New Zealand

Arch Osteoporos. 2022 Aug 2;17(1):108. doi: 10.1007/s11657-022-01138-1.

Authors

Christine Ellen Gill^{1

2}, Paul James Mitchell^{3

4

5

6

7}, Jan Clark¹, Jillian Cornish^{1

8

9}, Peter Fergusson¹, Nigel Gilchrist^{1

10}, Lynne Hayman¹, Sue Hornblow¹, David Kim^{1

2

9

11}, Denise Mackenzie^{1

2}, Stella Milsom^{1

12

13

14}, Adrienne von Tunzelmann¹, Elizabeth Binns^{15

16

17}, Kim Fergusson^{2

16

18

19}, Stewart Fleming^{2

16

20}, Sarah Hurring^{16

21}, Rebbecca Lilley^{16

22}, Caroline Miller¹⁶, Pierre Navarre^{16

23

24

25}, Andrea Pettett^{16

25}, Shankar Sankaran^{1

16}, Min Yee Seow^{11

16

26}, Jenny Sincock^{16

27}, Nicola Ward^{2

16

28}, Mark Wright^{16

25

29}, Jacqueline Clare Therese Close^{30

31

32}, Ian Andrew Harris^{30

33}, Elizabeth Armstrong^{34

35}, Jamie Hallen³⁴, Joanna Hikaka^{2

36}, Ngaire Kerse^{2

37}, Andrea Vujnovich^{2

38}, Kirtan Ganda^{39

40

41}, Markus Joachim Seibel^{39

42

43}, Thomas Jackson^{16

44}, Paul Kennedy⁴⁴, Kirsten Malpas^{2

44}, Leona Dann^{2

45}, Carl Shuker⁴⁵, Colleen Dunne⁴⁶, Philip Wood^{11

16

46}, Jay Magaziner^{47

48}, David Marsh⁴⁷, Irewin Tabu^{47

49

50}, Cyrus Cooper^{51

52

53

54}, Philippe Halbout⁵¹, Muhammad Kassim Javaid^{55

51}, Kristina Åkesson^{51

56

57}, Anastasia Soulié Mlotek⁵¹, Eric Brûlé-Champagne⁵¹, Roger Harris^{1

2

16}

Affiliations

¹ Osteoporosis New Zealand, Wellington, New Zealand.
² New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand.
³ Osteoporosis New Zealand, Wellington, New Zealand. paul.mitchell@nd.edu.au.
⁴ New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand. paul.mitchell@nd.edu.au.
⁵ School of Medicine, University of Notre Dame Australia, Sydney Campus, 128-140 Broadway, Chippendale, Sydney, NSW, 2007, Australia. paul.mitchell@nd.edu.au.
⁶ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. paul.mitchell@nd.edu.au.
⁷ Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland. paul.mitchell@nd.edu.au.
⁸ Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand.
⁹ Australian and New Zealand Bone and Mineral Society, Sydney, Australia.
¹⁰ CGM Research Trust, 40 Stewart Street, Christchurch, New Zealand.
¹¹ Waitemata District Health Board, Auckland, New Zealand.
¹² Fertility Associates, Auckland, New Zealand.
¹³ Auckland District Health Board, Auckland, New Zealand.
¹⁴ Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
¹⁵ Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand.
¹⁶ New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand.
¹⁷ Physiotherapy New Zealand, Wellington, New Zealand.
¹⁸ Fracture Liaison Network New Zealand, Wellington, New Zealand.
¹⁹ Fracture Liaison Service, Marlborough District Health Board, Nelson, Nelson, New Zealand.
²⁰ OperaIT Data Services, Logan, Queensland, Australia.
²¹ Older Persons' Health Specialist Service, Canterbury District Health Board, Christchurch, New Zealand.
²² Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
²³ Southland Hospital, Invercargill, New Zealand.
²⁴ University of Otago, Dunedin, New Zealand.
²⁵ New Zealand Orthopaedic Association, Wellington, New Zealand.
²⁶ Australian and New Zealand Society for Geriatric Medicine, Sydney, NSW, Australia.
²⁷ Canterbury District Heath Board, Christchurch, New Zealand.
²⁸ Bay of Plenty District Health Board, Tauranga, New Zealand.
²⁹ Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.
³⁰ Australian and New Zealand Hip Fracture Registry Steering Group, Sydney, Australia.
³¹ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.
³² Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
³³ Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, NSW, Australia.
³⁴ Australian Hip Fracture Registry, Neuroscience Research Australia, Sydney, NSW, Australia.
³⁵ School of Population Health, University of New South Wales, Sydney, Australia.
³⁶ Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
³⁷ School of Population Health, University of Auckland, Auckland, New Zealand.
³⁸ Auckland University of Technology, Auckland, New Zealand.
³⁹ Australian and New Zealand Fragility Fracture Registry Steering Group, Sydney, Australia.
⁴⁰ Department of Endocrinology, Concord Hospital, Concord, NSW, Australia.
⁴¹ Concord Clinical School, The University of Sydney, Sydney, NSW, Australia.
⁴² Bone Research Program, ANZAC Research Institute, Concord, NSW, Australia.
⁴³ Faculty of Medicine and Health, Sydney Medical School at Concord Campus, The University of Sydney, Sydney, NSW, Australia.
⁴⁴ Accident Compensation Corporation, Wellington, New Zealand.
⁴⁵ Health Quality & Safety Commission New Zealand, Wellington, New Zealand.
⁴⁶ Ministry of Health, Wellington, New Zealand.
⁴⁷ Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland.
⁴⁸ University of Maryland School of Medicine, Baltimore, MD, USA.
⁴⁹ Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
⁵⁰ Institute on Aging-National Institutes of Health, UP Manila, Manila, Philippines.
⁵¹ International Osteoporosis Foundation, Nyons, Switzerland.
⁵² MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
⁵³ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵⁴ NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
⁵⁵ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁵⁶ Department of Clinical Sciences, Lund University, Malmö, Sweden.
⁵⁷ Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.

Abstract

This narrative review describes efforts to improve the care and prevention of fragility fractures in New Zealand from 2012 to 2022. This includes development of clinical standards and registries to benchmark provision of care, and public awareness campaigns to promote a life-course approach to bone health.

Purpose: This review describes the development and implementation of a systematic approach to care and prevention for New Zealanders with fragility fractures, and those at high risk of first fracture. Progression of existing initiatives and introduction of new initiatives are proposed for the period 2022 to 2030.

Methods: In 2012, Osteoporosis New Zealand developed and published a strategy with objectives relating to people who sustain hip and other fragility fractures, those at high risk of first fragility fracture or falls and all older people. The strategy also advocated formation of a national fragility fracture alliance to expedite change.

Results: In 2017, a previously informal national alliance was formalised under the Live Stronger for Longer programme, which includes stakeholder organisations from relevant sectors, including government, healthcare professionals, charities and the health system. Outputs of this alliance include development of Australian and New Zealand clinical guidelines, clinical standards and quality indicators and a bi-national registry that underpins efforts to improve hip fracture care. All 22 hospitals in New Zealand that operate on hip fracture patients currently submit data to the registry. An analogous approach is ongoing to improve secondary fracture prevention for people who sustain fragility fractures at other sites through nationwide access to Fracture Liaison Services.

Conclusion: Widespread participation in national registries is enabling benchmarking against clinical standards as a means to improve the care of hip and other fragility fractures in New Zealand. An ongoing quality improvement programme is focused on eliminating unwarranted variation in delivery of secondary fracture prevention.

Keywords: Fracture liaison service; Fragility fracture; Registry; Systematic approach.

Publication types

Review

MeSH terms

Aged
Australia
Hip Fractures* / prevention & control
Humans
New Zealand / epidemiology
Osteoporosis* / complications
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / prevention & control
Secondary Prevention

Abstract

Publication types

MeSH terms

Grants and funding