VOLUME 6 - NUMBER 2 - 2026
Integrated care for people at high risk of fragility fractures: a partnership between
bone specialists and primary care professionals
-
Silvia Grignaschi, Ilaria Giovanna Macchione, Marta Baroni, Giuseppe Giuffrè, Andrea Giusti, Riccardo Bogini, Alessandro Rossi, Giuliana Duranti, Maria Cristina Caffetti, Carmelinda Ruggiero
-
Statement, 64-72
-
Full text PDF
-
-
Fragility fractures represent a major and growing public health challenge, with high socio-economic costs. Despite the availability of effective pharmacological and non-pharmacological interventions, secondary fracture prevention remains inconsistently delivered, particularly at the hospital–community interface. Real-world evidence shows that initiation of anti-osteoporosis treatment after hip fracture has increased over time, but remains inadequate. We describe an integrated model of care for people at high risk of fragility fractures, grounded in orthogeriatric principles and fracture liaison service (FLS) coordination and operationalised through structured collaboration with primary care. The model aligns acute care excellence (early geriatric co-management, early surgery, early rehabilitation) with longitudinal community-based management (case finding, fracture-risk assessment, treatment initiation and follow-up, fall prevention, adherence support and review). Evidence from randomised trials and meta-analyses supports orthogeriatric co-management for improved functional outcomes, while systematic reviews demonstrate that FLS models increase the initiation and persistence of osteoporosis therapy and reduce long-term refracture risk. We discuss core components, implementation enablers (shared indicators, digital communication, workforce training, case management), and policy opportunities—highlighting how contemporary territorial care reforms (e.g., Italy’s DM 77/2022) can support scalable “falls and fractures” pathways anchored in primary care and community services.
-
KEY WORDS: Fragility fractures, integrated care, hospital–community care.
