The Multidisciplinary Approach to Fragility Fractures Around the World: An Overview

Abstract

The basic argument for an orthogeriatric approach is that many patients presenting with fragility fracture need the simultaneous application of the skillsets of orthopaedic surgery and geriatric medicine. Recent thinking, encapsulated in the Global Call to Action (Dreinhöfer, Injury 49:1393–1397, 2018) has expanded the meaning of the term ‘orthogeriatrics’ to include all phases of post-fracture care, not just the immediate acute episode. These have come to be known as the three clinical ‘pillars’ of the Call to Action; the two additional elements are rehabilitation and secondary prevention. The book, therefore, tries to define what would be the ideal response from the moment of the first fragility fracture, for the rest of the patient’s life. The authors recognise that the recent progress that has occurred in developed economies may be difficult to reproduce in the emerging economies of Asia Pacific, Latin America and the Middle East. This is due to their relative paucity of resources in general, and geriatric medicine in particular. However, these are precisely the global regions where the population incidence of fragility fractures is expected to rise most sharply. The authors have therefore tried to define the principles of the orthogeriatric approach and to indicate how they might be delivered in low-resource settings. This first chapter is co-authored by the chairs of the working subcommittees and the presidential line of the Fragility Fracture Network. It, therefore, underlines the fact that the orthogeriatric approach is the heart of that organisation’s philosophy and raison d’être. This chapter functions as a roadmap to the rest of the book, wherein the chapters are grouped into:Background: epidemiology, osteoporosis, frailty and sarcopeniaPillar I: co-management in the acute episodePillar II: rehabilitation to restore function and independencePillar III: secondary preventionCross-cutting issues: nursing, nutrition and clinical audit (relevant in all three pillars) This chapter also addresses the fourth, political pillar—the formation of multidisciplinary national alliances, aimed at advocating change in healthcare policy and priorities that will enable the implementation of the three clinical pillars.