Capture the Fracture: Overview
A global campaign for the secondary
prevention of fractures by
facilitating the implementation of
Fracture Liaison Services (FLS)
Professor Cyrus Cooper, MA, DM, FRCP, FFPH, FMedSci
Director & Professor of Rheumatology, MRC Lifecourse Epidemiology Unit; Vice Dean, Faculty of
Medicine, University of Southampton; and Professor of Musculoskeletal Science, University of Oxford.
Acknowledgements
Capture the Fracture Steering Committee:
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Prof Kristina Åkesson, Chair Capture the Fracture, Skåne University Hospital SWE
Prof Cyrus Cooper, Chair IOF Committee of Scientific Advisors, MRC Lifecourse
Epidemiology Unit, University of Southampton & University of Oxford UK
Dr Alastair McLellan, Gardiner Institute Western Infirmary UK
Paul Mitchell, Synthesis Medical Limited NZL
Dr Kassim Javaid, University of Oxford UK
Judy Stenmark, Chief Executive Officer, IOF
Dr Dominique Pierroz, Science Manager, IOF
Carey Kyer, Capture the Fracture Coordinator, IOF
Dr Muriel Schneider, Capture the Fracture Coordinator, IOF
With additional support from
• Charlotte Moss, MRC Lifecourse Epidemiology Unit, University of Southampton UK
Capture the Fracture
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The need for secondary fracture prevention
The Capture the Fracture campaign
How to get involved
Initial results
Effectiveness of secondary fracture
prevention
Amongst post-menopausal women, the majority of the population have not suffered fragility
fractures.
Case-finding
strategies prioritising
assessment
women
with prior
could
Amongst
post-menopausal
women, the
majority ofofthe
population
have fracture
not suffered
identifyfragility
50% offractures.
potentialCase-finding
hip fracture cases
from prioritising
16% of theassessment
population of women with prior
strategies
fracture could identify 50% of potential hip fracture cases from 16% of the population
Post-menopausal
women with new
fracture each year
0.2 million
Post-menopausal
women with prior
fracture history
50% of hip
fractures from
16% of the
population
1.8 million
Post-menopausal
women with
osteoporosis
3.4 million
Post-menopausal
women
11.1 million
50% of hip
fractures from
84% of the
population
Adapted from Brankin E, et al. Curr Med Res Opin 2005;21:4:475-482
Coordinator-based systems for secondary prevention of
fragility fracture
A Report of the IOF CSA Fracture Working Group
• Systematic review of the literature (48 studies)
• Programmes used in clinical settings to facilitate
guideline-based osteoporosis care following a
fragility fracture
• Key components:
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Dedicated coordinator
BMD provision
Physician and patient education
Patient follow-up within programme
Implementation audit
Economic analysis
Marsh D et al Osteop Int 2011; 22: 2051-65
Campaign structure to facilitate the implementation of
Fracture Liaison Services (FLS)
Set Standards
Facilitate
Change
Create
Awareness
• Best Practice Framework
• Best Practice Recognition/application
• Showcase of Best Practices/map
• Mentorship programme
• Implementation guides & toolkits
• Facilitated grant support
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Website www.capturethefracture.org
Resources
Communication/marketing
Coalition of partners
Main Programme
Purpose of the Best Practice Framework
13 internationally recognized & endorsed standards of
care for secondary fracture prevention
1. Set the standard for FLS
2. Assign quality level
3. Benchmarking of global
service delivery
Standard
Level 1
Level 2
Level 3
1.Patient Identification
Patients ID’d, not tracked
Patients ID’d, are tracked
Patients ID’d, tracked &
Independent review
2.Patient Evaluation
50% assessed
70% assessed
90% assessed
3.Post Fracture
Assessment Timing
Within 13-16 weeks
Within 9-12 weeks
Within 8 weeks
4.Vertebral Fracture (VF)
Known VF assessed
Routinely assesses for VF
Radiologists identify VF
5.Assessment Guidelines
Local
Regional
National
6.Secondary Causes
50% of patients screened
70% of patients screened
90% of patients screened
7.Fall Prevention Services
50% of patients evaluated
70% of patients evaluated
90% of patients evaluated
8.Multifaceted
assessment
50% of patients screened
70% of patients screened
90% of patients screened
9.Medication Initiation
50% of patients initiated
70% of patients initiated
90% of patients initiated
10.Medication Review
50% assessed
70% assessed
90% assessed
11.Communication Strategy
Communicates to doctor
Communicates to doctor
w/ %50 criteria
Communicates to doctor
w/ %90 criteria
12.Long-term
Management
1 year follow-up
13.Database
Local
6 month follow-up & 1
year follow-up
Regional
National
13 standards
1.
2.
3.
4.
5.
5 categories
Fragility fracture
categories
Achievement &
valuation
Hip
Inpatient
Outpatient
Vertebral
Organizational
=1
1 star
= 0.5
= 0.25
=0
FLS Overall summary profile
Star Grade
Hip
Inpt
OPD
Vert
Calculation
Score
1+1+1+0.25+0.5
3.75
Map recognition
Org
3.75
The Process
Step 1
Step 2
Step 3
Step 4
FLS submits online
application
FLS entered on
global map while
being reviewed
BPF achievement
level assigned
FLS is scored and
recognized on the
map
Current mapping of FLS services
51 complete
8
19
24
29 in review
80 FLS
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Algeria
Australia
Belgium
Brazil
Bulgaria
Canada
China
Czech Republic
Finland
France
Greece
India
Ireland
Italy
Netherlands
New Zealand
Portugal
Singapore
Spain
Sweden
Switzerland
Taiwan
Trinidad & Tobago
UK
USA
NEW! CtF toolkit
When?
Available by the end of November 2014
What is it?
A guide to facilitate the implementation of FLS worldwide
For whom?
HCPs, health administrators, policymakers
Get Involved
Providers, politicians & patients drive change
• Visit www.capturethefracture.org to:
 Get mapped – Submit your FLS
 Join the coalition
 Sign up for the newsletter
• Be Active:
 Advocate for FLS implementation
 Encourage existing FLS to participate in Capture the Fracture
 Spread the word about FLS
capturethefracture@iofbonehealth.org
www.capturethefracture.org