LAUSR

On January 24, 2019, a member of the National Assembly held a public hearing in the National Assembly Members’ Office. This public hearing was aimed at promoting the development of a comprehensive integrated fragility fracture care system for geriatric patients. The hearing involved active discussions and suggestions for the prevention of fragility fractures, multidisciplinary care, and rehabilitation. Osteoporotic fracture or fragility fracture has been recognized as a geriatric disease manifesting with various and complex problems that have a significant detrimental effect on whole-body condition and function as well as musculoskeletal problems due to the fracture itself. The term “geriatric fracture” has been also used to address the nature of fragility fractures, that can be more easily understood, and is better to attract public awareness. The annual incidence of fragility fractures exceeds 150 hip fractures per 100,000 people in the most developed countries. Moreover, there have been rapid increases in hip fracture rates in several major countries with high populations, such as China and India. In Korea, the incidence of hip fractures continues to increase. Regarding the functional trajectory throughout life, frail older adults are vulnerable to fall and fall-related injuries. They may experience a severe functional decline or may be unable to survive; however, with proper management, some older adults are able to return to their previous levels of function. Fall-related fractures in late life may threaten independence, sometimes to levels below the disability threshold. Partially recovered patients often have a lower functional state. Repeated fall and related fractures could lead to a more severe functional decline or even death. However, successful fragility fracture care allows patients to return to their previous levels of functioning. In an ideal scenario, although repeated falls and fractures may occur, older adults could maintain their original functional capacities. Diverse components can be targeted for fragility fracture care, with the main goal of restoring the previous level of function and preventing repeated fractures. Fragility fractures are a geriatric disease with multiple risk factors and comorbidities. Therefore, we need a multidisciplinary approach to achieve a good outcome after a fragility fracture. However, we face several barriers in fragility fracture care. For example, there are substantial gaps between service delivery and practice. Patient barriers also exist. Most patients and their families have low levels of awareness of post-acute care. Insufficient medical and surgical leadership and lacking hospital administration support are also problems. Furthermore, integrated care systems involving orthopedic surgeons, geriatricians, and rehabilitation specialists are quite limited. Therefore, communication and collaboration do not work well in real world clinical practice. Fracture Liaison Services (FLS) are systems developed to ensure that fracture risk assessment and treatment are provided to all patients with fragility fractures. FLS have been implemented in many countries as standard care for fragility fractures. International initiatives on fragility fracture care to promote FLS in each country or region have emerged. The Fragility Fracture Network (FFN) is a leading global initiative aimed at promoting multidisciplinary management and secondary prevention among patients with fragility fractures. The FFN declared a Global Call to Action on fragility fractures to improve the care of people with fragility fractures. There is an urgent need to improve: 1) acute multidisciplinary care for individuals with hip, clinical vertebral, or other major fragility fractures; 2) rapid secondary prevention to prevent future fractures after the first occurrence of fragility fracture in both younger and older individuals; 3) ongoing post-acute care for individuals with impaired functional capacities caused by hip and major fragility fractures. More than 80 leading organizations worldwide in the fields of medicine and nursing for older people have endorsed the Global Call to Action. Recently, the Korean Geriatrics Society, the Korean Society for Bone and Mineral Research, and the Korean Academy of Rehabilitation Medicine have also endorsed the Global Call to Action. The FFN has translated the Global Call to Action into the world’s major languages.