Several studies have explored this phenomenon from the obverse view of fracture history in patients presenting to hospital with a hip fracture. In 1980, Gallagher and colleagues reported prior fracture history amongst patients presenting with hip fracture in Rochester, USA for the period 1965–1974 [5]. Sixty-eight percent of women and 59% of men had

suffered at least one other fracture besides their hip fracture. More recent studies from the UK [6], USA [7] and Australia [8] have consistently reported that 45% or more of today’s hip fracture patients have a prior fracture history. These epidemiological data reveal a stark truth; almost half of hip fracture patients provide us with an obvious opportunity for preventive intervention. Tragically, numerous www.selleckchem.com/products/sbe-b-cd.html studies from across the world have found that healthcare systems are failing to respond to the first fracture to prevent the second [9, 10]. This special issue of Osteoporosis International focuses on post-fracture coordinator-based models that have been shown to close the

secondary prevention management gap. The systematic review conducted by Sale and colleagues [11] considered published models of case-finding systems in the orthopaedic environment. The reviewers sought to evaluate the structure, protocols, staffing and outcomes of different models and categorise them by the key elements present in each program. Sixty-five percent formally described the role of a dedicated coordinator who identified check details patients, facilitated BMD testing and the initiation of osteoporosis treatment. A clear message is that coordinator-based models circumvent the challenge of where clinical responsibility resides for osteoporosis care of the fragility fracture patient. The Glasgow Fracture Liaison Service (FLS) has provided clinically effective post-fracture osteoporosis care for the one

million residents of Glasgow, Scotland for the last decade [12]. McLellan and colleagues’ formal cost-effectiveness analysis of the Glasgow FLS [13] provides crucial health economic information in the prevailing austere economic climes. An estimated 18 fractures were prevented, including 11 hip Rebamipide fractures, and £21,000 (€23,350, US$34,700) was saved per 1,000 patients managed by the FLS versus “usual care” for the United Kingdom. To date, approximately one third of the UK’s 61 million residents are served by an FLS. McLellan has estimated that universal access for the UK could be achieved at a cost of £9.7 million (€10.8 million, US$16 million), which represents 0.6% of the £1.7 billion (€1.9 billion, US$2.8 billion) [14] estimated annual cost of hip fracture care alone to the UK economy. In response to the emerging evidence on the clinical and cost-effectiveness of coordinator-based models of care, the Fracture KPT-330 clinical trial Working Group of the International Osteoporosis Foundation (IOF) has published an IOF Position Paper [15] in this issue.