Geriatric Trauma Centre, University Hospital Zurich

Geriatric Trauma Centre, University Hospital Zurich, Zurich, Switzerland
Dept. of Geriatrics: Prof. Heike A. Bischoff-Ferrari, MD DrPH + Dr. Otto Meyer, MD + Thomas Degen, MD
Dept of Traumatology: Prof. Hans-Peter Simmen + Prof. Guido Wanner + Dr. Valentin Neuhaus, MD

The University Hospital in Zurich has established a Geriatric Trauma Centre between the Departments of Geriatrics and Traumatology to offer complete fracture liaison service (FLS) targeting for all fracture patients aged 70+.  These patients are seen within 24 hours by the geriatrician, followed by a short assessment, initiation of vitamin D supplementation, and definition of the acute peri-operative treatment plan.  Patients with a high probability of benefitting from early rehabilitation during acute care are transferred to the Geriatric Department to initiate “early complex treatment rehabilitation” within an intense multi-disciplinary approach. This involves nurses trained to active patients in their ADLs, physiotherapists, ergo therapists, nutrition experts, social workers, and MDs trained in geriatrics and musculoskeletal rehabilitation.

Secondary prevention: All patients 70+ with a fragility fracture are scheduled for their first follow-up visit “Capture the fracture and the fall outpatient clinic” within 8 weeks of their fracture. This visit includes a follow-up exam by the geriatrician and the traumatologist, DXA measurement of BMD and vertebral morphometry, FRAX, sarcopenia assessment and a comprehensive Geriatric Assessments to capture also the fall as the primary risk factor for fragility fractures.  The Geriatric Assessment for fall and fragility fracture prevention includes: malnutrition, strength, gait speed, SPPB, frailty, cognitive function, blood test regarding vitamin D, Folate and B12 deficiency, screening for medications that promote falls, screening visual und hearing impairment, and screening for depression.

Once all tests are evaluated, a treatment plan for secondary fracture prevention targeting both bone health (pharmacologic treatments according to FRAX treatment threshold) and fall prevention.

For fall prevention after a fracture, all patients receive a manual and are instructed by a physiotherapist to perform an evidence-based home exercise program1 for fall prevention after a fracture.

For the support of bone and muscle health, the fracture care MD reviews the IOF brochure “3 steps to unbreakable bones” 2 with the patient and a copy of the brochure is provided to the patient to follow these steps at home.

Vitamin D supplementation is discussed and re-enforced for both fall and fracture prevention 3.

1. Bischoff-Ferrari HA, et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 2010.
2. Three steps to unbreakable bones: vitamin D, calcium and exercise
Bischoff-Ferrari HA. Brochure available at
http://www.iofbonehealth.org/three-steps-unbreakable-bones-0

3. Bischoff-Ferrari HA, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009
Bischoff-Ferrari HA,et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012