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: 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 The need for secondary fracture prevention The Capture the Fracture campaign How to get involved Initial results

Effectiveness of secondary fracture prevention Adapted from Brankin E, et al. Curr Med Res Opin 2005;21:4: Amongst post-menopausal women, the majority of the population have not suffered fragility fractures. Case-finding strategies prioritising assessment of women with prior fracture could identify 50% of potential hip fracture cases from 16% of the population

Systematic review of the literature (48 studies) Programmes used in clinical settings to facilitate guideline-based osteoporosis care following a fragility fracture Key components: Dedicated coordinator BMD provision Physician and patient education Patient follow-up within programme Implementation audit Economic analysis Coordinator-based systems for secondary prevention of fragility fracture A Report of the IOF CSA Fracture Working Group Marsh D et al Osteop Int 2011; 22:

Campaign structure to facilitate the implementation of Fracture Liaison Services (FLS) Best Practice Framework Best Practice Recognition/application Showcase of Best Practices/map Mentorship programme Implementation guides & toolkits Facilitated grant support Website Resources Communication/marketing Coalition of partners Set Standards Facilitate Change Create Awareness 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

StandardLevel 1Level 2Level 3 1.Patient IdentificationPatients ID’d, not trackedPatients ID’d, are trackedPatients ID’d, tracked & Independent review 2.Patient Evaluation50% assessed70% assessed90% assessed 3.Post Fracture Assessment Timing Within weeksWithin 9-12 weeksWithin 8 weeks 4.Vertebral Fracture (VF)Known VF assessedRoutinely assesses for VFRadiologists identify VF 5.Assessment GuidelinesLocalRegionalNational 6.Secondary Causes50% of patients screened70% of patients screened90% of patients screened 7.Fall Prevention Services50% of patients evaluated70% of patients evaluated90% of patients evaluated 8.Multifaceted assessment 50% of patients screened70% of patients screened90% of patients screened 9.Medication Initiation50% of patients initiated70% of patients initiated90% of patients initiated 10.Medication Review50% assessed70% assessed90% assessed 11.Communication StrategyCommunicates to doctorCommunicates to doctor w/ %50 criteria Communicates to doctor w/ %90 criteria 12.Long-term Management 1 year follow-up6 month follow-up & 1 year follow-up 13.DatabaseLocalRegionalNational

13 standards 5 categories1 star Fragility fracture categories Achievement & valuation 1.Hip 2.Inpatient 3.Outpatient 4.Vertebral 5.Organizational = 1 = 0.5 = 0.25 = 0 FLS Overall summary profile Star GradeCalculationScoreMap recognition HipInptOPDVertOrg

The Process Step 1 FLS submits online application Step 2 FLS entered on global map while being reviewed Step 3 BPF achievement level assigned Step 4 FLS is scored and recognized on the map

51 complete 29 in review FLS 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 Current mapping of FLS services

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 Visit 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 Providers, politicians & patients drive change