Can secondary fracture prevention reduce social inequality in health and improve quality of life after hip fractures?

PhD student: Sturla Einarsson

Supervisors:

• Associated professor Ann Kristin Hansen (main supervisor), University Hospital of North Norway, UiT – The Arctic University of Norway
• Associated professor Cato Kjærvik, UiT – The Arctic University of Norway
• Professor Åshild Bjørnerem, Oslo University Hospital, UiT – The Arctic University of Norway
• Professor Tone Kristin Omsland, University of Oslo
• Professor Jan-Erik Gjertsen, University of Bergen, Haukeland University Hospital

Collaborators:

• Frida Igland Nissen, University Hospital of North Norway, UiT – The Arctic University of Norway
• Ragnar Joakimsen, University Hospital of North Norway, UiT – The Arctic University of Norway
• Tove Tveitan Borgen, Drammen Hospital
• Lene B Solberg, Oslo University Hospital
• Frede Frihagen, University of Oslo
• Peter Vestergaard, Aalborg University Hospital, Denmark

Secondary fracture prevention is important because a fracture doubles the risk of a future fracture. Anti-osteoporosis drugs can reduce the risk of a future fracture by 30-50%. Still, after a fracture of the hip or forearm, only 11-15% of women and 3-4% of men are treated with anti-osteoporosis drugs. Most patients who suffer a fracture are not tested or treated for osteoporosis. 

Policy makers have overlooked this problem for too long and has not given it the proper priority. To close the care gap, it is internationally recommended to establish a fracture liaison service (FLS). A FLS is a model of care, where dedicated nurses identify fracture cases, assess their fracture risk, and offer anti-osteoporosis drugs, to improve the patient outcome, save money, and save lives. 

In this current project, the long-term aim is to ensure that all patients receive optimal care and secondary fracture prevention when needed, regardless of sex, educational level, income, or poverty. We will investigate whether a fracture liaison service reduces social inequality in health and improve the quality of life, e.g., mental well-being, pain and physical function after hip fractures. 

With an aging population, expected increase in the burden of future fractures alongside increasing social inequalities in Norway, there is a need to identify determinants of social inequalities in fracture care and develop and implement preventive strategies to achieve health equity. Effective measures to maintain a healthy elderly population are important as the number of elderly increases. 

The new knowledge from this project is expected to facilitate the implementation of a fracture liaison service as a clinical routine and improve follow-up of patients at high-risk for future fracture and mortality. This knowledge is very much needed to inform patients, healthcare providers, politicians, and decision-makers about the importance and benefit of secondary fracture prevention.

Link:

Åshild Marit Bjørnerem (homepage at uit.no)