The Hospital Universitario Infanta Leonor in Madrid, Spain started up seven years ago. This offered an opportunity - and a challenge. From the very first beginning it was clear that fragility fracture – and ‘capturing the fracture’ in high-risk patients was one of the challenges that had to be faced.
Hip fracture in elderly patients is the key focus. Shared care models between orthopedic surgeons and geriatricians have demonstrated benefits in terms of health for the patients and in terms of costs for the system. Since the beginning the fracture liaison service has worked collaboratively, creating an orthogeriatric unit. It has integrated all the professionals involved in patient care: anesthesists, physiotherapists, operating room nurses, ward nurses, primary care, support hospitals, nursing homes, social workers etc
This goal has had good results: hip fracture patients are part of a clinical care process integrated by all the professionals involved. An independent head manager of the entire process reports directly to the Hospital Director. As the first clinical care process, the Hospital can proudly say that the entire organization is at the service of these high-risk patients.
Patients with other fragility fractures are treated too. A challenge ahead is to identify patients at high risk of fragility fracture and this means all those who have sustained a fragility fracture. At this point the orthopedic and rehabilitation physicians act as sentinels, treating the fracture and functional recovery but also referring patients to internists and rheumatologists for assessment the need for specific action, especially pharmacological treatment.
The most ineffective drug is one that is not taken - but still more ineffective is the one prescribed to someone who does not need it. Economic optimization is critical for the rational use of resources and identifying high-risk patients is the first step to try to achieve the goal: making the first fragility fracture last. Thanks to its great motivation and efforts to unify criteria and medical interventions, important steps have been made to “capture the fracture”.