Review

. 2022 Aug 2;17(1):108.

doi: 10.1007/s11657-022-01138-1.

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

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.

PMID: 35917039
PMCID: PMC9344235
DOI: 10.1007/s11657-022-01138-1

Review

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

Christine Ellen Gill et al. Arch Osteoporos. 2022.

. 2022 Aug 2;17(1):108.

doi: 10.1007/s11657-022-01138-1.

Authors

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.

PMID: 35917039
PMCID: PMC9344235
DOI: 10.1007/s11657-022-01138-1

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.

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Conflict of interest statement

Christine Ellen Gill is the Executive Director of Osteoporosis New Zealand and has no disclosures relating to this work. Adjunct Associate Professor Paul James Mitchell has undertaken consultancy for governments, national and international osteoporosis societies, healthcare professional organisations and private sector companies relating to systematic approaches to fragility fracture care and prevention since 2005. Jan Clark reports no disclosures relating to this work. Professor Jillian Cornish reports no disclosures relating to this work. Peter Fergusson reports no disclosures relating to this work. Dr. Nigel Gilchrist reports no disclosures relating to this work. Lynne Hayman reports no disclosures relating to this work. Sue Hornblow reports no disclosures relating to this work. Dr. David Kim reports no disclosures relating to this work. Denise Mackenzie reports no disclosures relating to this work. Dr. Stella Milsom reports no disclosures relating to this work. Adrienne von Tunzelmann reports no disclosures relating to this work. Elizabeth Binns reports no disclosures relating to this work. Kim Fergusson reports no disclosures relating to this work. Stewart Fleming reports no disclosures relating to this work. Dr. Sarah Hurring reports no disclosures relating to this work. Dr. Rebbecca Lilley reports no disclosures relating to this work. Caroline Miller reports no disclosures relating to this work. Dr. Pierre Navarre reports consultancy and payment for development of educational presentations from DePuy Synthes and travel/accommodations/meeting expenses from Stryker, both unrelated to this publication. Andrea Pettett is Chief Executive Officer of the New Zealand Orthopaedic Association and reports no disclosures relating to this work. Dr. Shankar Sankaran reports no disclosures relating to this work. Dr. Min Yee Seow reports no disclosures relating to this work. Jenny Sincock reports no disclosures relating to this work. Nicola Ward reports no disclosures relating to this work. Mr. Mark Wright, FRACS, Orthopaedic Surgeon, reports no disclosures relating to this work. Professor Jacqueline Clare Therese Close reports no disclosures relating to this work. Professor Ian Andrew Harris reports no disclosures relating to this work. Elizabeth Armstrong is supported by an Australian Government Research Training Programme (RTP) Scholarship and reports no disclosures relating to this work. Jamie Hallen reports no disclosures relating to this work. Dr. Joanna Hikaka reports no disclosures relating to this work. Professor Ngaire Kerse reports no disclosures relating to this work. Dr. Andrea Vujnovich reports no disclosures relating to this work. Dr. Kirtan Ganda reports no disclosures relating to this work. Professor Markus Joachim Seibel reports no disclosures relating to this work. Thomas Jackson reports no disclosures relating to this work. Paul Kennedy reports no disclosures relating to this work. Kirsten Malpas reports no disclosures relating to this work. Dr. Leona Dann reports no disclosures relating to this work. Carl Shuker reports no disclosures relating to this work. Colleen Dunne reports no disclosures relating to this work. Dr. Philip Wood reports no disclosures relating to this work. Professor Jay Magaziner reports membership of the Own the Bone® Multidisciplinary Advisory Board of the American Orthopedic Association and membership of the Board of the Fragility Fracture Network. Professor David Marsh reports no disclosures relating to this work. Associate Professor Irewin Tabu reports no disclosures relating to this work. Professor Cyrus Cooper has received consulting fees and honoraria from Amgen, Danone, Eli Lilly, GSK, Medtronic, Merck, Nestle, Novartis, Pfizer, Roche, Servier, Shire, Takeda and UCB. Dr. Philippe Halbout is the Chief Executive Officer of the International Osteoporosis Foundation and has no disclosures relating to this work. Associate Professor Muhammad Kassim Javaid reports in the last three years receiving honoraria, unrestricted research grants, travel and/or subsistence expenses from Amgen, Consilient Health, Kyowa Kirin Hakin, UCB, Besin Healthcare and Sanofi. Professor Kristina Åkesson has undertaken consultancy for government related agencies, international and national osteoporosis societies and private sector companies related to osteoporosis and fracture prevention during the past 5 years. Anastasia Soulié Mlotek reports no disclosures relating to this work. Eric Brûlé-Champagne reports no disclosures relating to this work. Dr. Roger Harris reports no disclosures relating to this work.

Figures

**Fig. 1**
Old-age dependency ratios for the world, Asia and New Zealand from 1950 to 2100 [3] (from World Population Prospects: Volume II: Demographic Profiles 2017 Revision. ST/ESA/SER.A/400, by Department of Economic and Social Affairs, Population Division, ©2017 United Nations. Reprinted with the permission of the United Nations)

**Fig. 2**
A systematic approach to fragility fracture care and prevention for New Zealand [9] (reproduced with kind permission of Osteoporosis New Zealand)

**Fig. 3**
Proportion of Australian and New Zealand Hospitals reporting specific services beyond the acute stay from 2014 to 2020 [31] (reproduced with kind permission of the Australian and New Zealand Hip Fracture Registry)

**Fig. 4**
Proportion of hip fracture patients who underwent preoperative cognitive assessment during acute admissions to hospitals in Australia and New Zealand during 2020 [31] (reproduced with kind permission of the Australian and New Zealand Hip Fracture Registry)

**Fig. 5**
Bone Health New Zealand Know your Bones™ television commercial [62] (reproduced with kind permission of Osteoporosis New Zealand)

See this image and copyright information in PMC

References

1. Mitchell PJ, Magaziner J, Costa M, Seymour H, Marsh D, Falaschi P, Beaupre L, Tabu I, Eleuteri S, Close J, Agnusdei D, Speerin R, Kristensen MT, Lord S, Rizkallah M, Caeiro JR, Yang M (2020) FFN Clinical Toolkit. 1st Edition. Fragility Fracture Network. Zurich. https://fragilityfracturenetwork.org/. Accessed 20 July 2022
1. Cooper C and Ferrari S, on behalf of the IOF Board and Executive Committee (Reginster JY, Chair of Committee of National Societies; Dawson-Hughes B, General Secretary; Rizzoli R, Treasurer; Kanis J, Honorary President; Halbout P, CEO) (2019) IOF Compendium of Osteoporosis. 2nd Edition. Writer: Mitchell P. Reviewers: Harvey N and Dennison E. International Osteoporosis Foundation. Nyons. https://www.osteoporosis.foundation/educational-hub/files/iof-compendium.... Accessed 20 July 2022
1. United Nations Department of Economic and Social Affairs Population Division (2017) World Population Prospects: Volume II: Demographic Profiles 2017 Revision (ST/ESA/SER.A/400). New York
1. Accident Compensation Corporation (2021) Accident Compensation Corporation website. https://www.acc.co.nz/. Accessed 20 July 2022
1. Accident Compensation Corporation (2020) Live Stronger for Longer Board Paper October 2020. Wellington

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical