First Croatian FLS joins the Capture the Fracture® Network

In March 2023, Dubrava University Hospital joined the Capture the Fracture^® (CTF) Network, making Croatia the 54th country to be represented on the global Map of Best Practice. 

The Capture the Fracture^® (CTF) programme was delighted to welcome the first FLS from Croatia in March 2023. We interviewed Dr Vlatka Pandzic Jaksic, Endocrinologist and FLS coordinator, to learn more about the Dubrava University Hospital FLS and the post-fracture care landscape in Croatia.

What was your inspiration to join the Capture the Fracture^® network?

“The Fracture liaison service in Dubrava University Hospital in Croatian capital Zagreb was organized as an initiative of the Department of Endocrinology, Diabetes, Metabolic Diseases and Clinical Pharmacology. As endocrinologists we work in close collaboration with orthopaedists/traumatologists and physical medicine specialists treating patients with fragility fractures that are secondary to some endocrine and metabolic disorders. We have been aware that without a better coordination of our different specialties, many other high-risk patients were not receiving post-fracture care and timely osteoporosis treatment. Without this intervention their risk of developing a cascade of fractures is considerably higher. Hoping to see fewer patients with such multiple fragility fractures, we realized we were missing the opportunity for efficient secondary fracture prevention. In our search for models to organize FLS, the Capture the Fracture^® Network distinguished itself with the sense of a successful global community. It inspired us to persist in our goals and overcome challenges for implementing FLS in the busy everyday rhythm of our hospital wards.”

How do you hope the Capture the Fracture^® programme will be helpful for your FLS?

“Capture the Fracture^® is an international framework that provides well-defined goals and criteria for FLS implementation. It is at the same time sufficiently structured but could also be adapted to different health care systems. The systematic approach with standards that need to be achieved is a motivation point that promotes better performance. This is also an opportunity to compare our work and learn from successful stories of other centres throughout the globe. With better performance, we hope to provide sufficient arguments in front of our hospital management to assure devoted personnel for FLS. For the moment, our endocrinology residents are of immense help in screening patients for FLS.

Capture the Fracture^® is also a distinctive brand under the sponsorship of a leading international professional organization which can be easily recognised. In Dubrava University Hospital we hope that this will help us to raise awareness about secondary fracture prevention in Croatia and promote its wider professional and public acceptance.”

What is the post-fracture care and FLS situation in Croatia from your perspective?

“While physical rehabilitation within post-fracture care in Croatia is easily accessible and routinely provided, the liaison with metabolic bone units usually depends on the sole initiative of individual family physicians. Only some orthopaedists and traumatologists insist that patients find their way to get the needed osteoporosis treatment. On the other hand, metabolic bone units inside endocrinology departments are still occasionally visited by menopausal women and DXA is performed without specific indication, and at an age when their actual fracture risk is low. In this way health care resources have not been spent in a cost-effective way and patient benefit has not been achieved.

The reality is that among medical professionals the concept of FLS is well-known, but only on a theoretical level. This topic has been repeatedly approached for years – usually addressed at pharma industry sponsored events and forgotten soon afterwards. These circumstances might even have a rebound negative effect on FLS adoption.   Finally, major barriers for wider FLS implementation in Croatia are the high amount of work and coordination needed together with the lack of the clear national policy to reduce the burden of fragility fractures in an ageing population.”