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

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.

Implementation of fracture liaison service in a New Zealand public hospital: Waitemata district health board experience.

AIM: To analyse the performance of a Fracture Liaison Service (FLS) at Waitemata District Health Board (WDHB), and to detail how systematic secondary fracture prevention can be delivered in a secondary healthcare setting in New Zealand. METHOD: Clinical details of patients supervised by the WDHB FLS during the calendar year 2014 were reviewed and analysed. Additional information including treatment compliance and re-fracture rates were sought a year after initial intervention. RESULTS: During the 12-month period, 301 patients with fragility fracture were seen by the WDHB FLS. All patients had clinical and laboratory assessment, one-to-one education by the FLS co-ordinator. One hundred and twenty-one patients had dual energy x-ray absorptiometry (DEXA) performed. One hundred and thirty-four of 226 treatment naive patients were started or recommended to be started on a bone protection therapy, bisphosphonate in almost all cases, and another 25 of 75 patients had adjustment made to their current therapy. Of those who were started or continued on treatment, adherence rate was 70% at a mean follow-up of 12 months. CONCLUSION: An effective secondary fracture prevention programme, such as a FLS, can be successfully implemented in a New Zealand district hospital setting.