Osteoporos Int. 2013 Aug;24(8):2135-52.

Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle.

Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C; IOF Fracture Working Group.

Department of Orthopaedics Malmo, Skåne University Hospital, Malmo, Sweden.



The International Osteoporosis Foundation (IOF) Capture the Fracture Campaign aims to support implementation of Fracture Liaison Services (FLS) throughout the world.

INTRODUCTION: FLS have been shown to close the ubiquitous secondary fracture prevention care gap, ensuring that fragility fracture sufferers receive appropriate assessment and intervention to reduce future fracture risk.

METHODS: Capture the Fracture has developed internationally endorsed standards for best practice, will facilitate change at the national level to drive adoption of FLS and increase awareness of the challenges and opportunities presented by secondary fracture prevention to key stakeholders. The Best Practice Framework (BPF) sets an international benchmark for FLS, which defines essential and aspirational elements of service delivery.

RESULTS: The BPF has been reviewed by leading experts from many countries and subject to beta-testing to ensure that it is internationally relevant and fit-for-purpose. The BPF will also serve as a measurement tool for IOF to award ‘Capture the Fracture Best Practice Recognition’ to celebrate successful FLS worldwide and drive service development in areas of unmet need. The Capture the Fracture website will provide a suite of resources related to FLS and secondary fracture prevention, which will be updated as new materials become available. A mentoring programme will enable those in the early stages of development of FLS to learn from colleagues elsewhere that have achieved Best Practice Recognition. A grant programme is in development to aid clinical systems which require financial assistance to establish FLS in their localities.

CONCLUSION: Nearly half a billion people will reach retirement age during the next 20 years. IOF has developed Capture the Fracture because this is the single most important thing that can be done to directly improve patient care, of both women and men, and reduce the spiralling fracture-related care costs worldwide.

PMID: 23589162capture_the_fracture-logoWorldwide, a fragility fracture is estimated to occur every 3 seconds. This amounts to almost 25,000 fractures per day or 9 million per year. The human suffering associated with these common serious injuries is immense and the financial costs are staggering. The cost of fragility fractures to European healthcare systems is in excess of €37 billion each year1, and 20 billion USD per year in the United States, which shows the immense burden that osteoporosis imposes on the world’s economy.

The underlying cause of fragility fractures is osteoporosis, a chronic disorder which weakens bones and leaves them easily susceptible to fracture, even after a minor bump or fall.

The situation is predicted to worsen as the population ages. In China, the 1.6 billion USD spent on hip fracture care in 2006 is set to rise to 12.5 billion USD by 2020 and 265 billion USD by 2050. Similar changes are projected across Asia, Latin America and the Middle East. In the European Union the number of men and women with osteoporosis is expected to increase by 23% from 2010 to 2025, when an estimated 33.9 million people will have osteoporosis.

Nature has provided us with an opportunity to systematically identify a significant proportion of individuals that will suffer fragility fractures in the future. This is attributable to the well recognized phenomenon that fracture begets fracture. Those patients that suffer a fragility fracture today are much more likely to suffer fractures in the future; in fact, they are twice as likely to fracture as their peers -who haven’t fractured. From the obverse view, we have known for three decades that almost half of patients presenting with hip fractures have previously broken another bone.

Science has provided us with a broad spectrum of effective pharmacological agents to reduce the risk of future fractures. These medicines have been shown to reduce fracture rates amongst individuals with and without fracture history, and even amongst those that have already suffered multiple fractures. Governments and private sector healthcare providers have recognized the opportunity for ‘secondary fracture prevention’, by creating policies and reimbursement criteria that support treatment of osteoporosis for patients presenting with fragility fractures. They have done so to improve the quality of care for those at risk of suffering future fractures, and because such strategies have been shown to be highly cost-effective by many agencies responsible for resource allocation.

Regrettably, by missing the opportunity to respond to the first fracture, healthcare systems around the world are failing to prevent the second and subsequent fractures. Numerous audits of secondary preventive care show that the majority of fragility fracture patients never learn about the underlying cause of their fracture, or receive treatment to prevent it from happening again. However, there is reason for optimism. Innovators in many countries have tackled this health care delivery challenge and created systems that close the current care gap. These systems, often referred to as fracture liaison services (FLS), have a dedicated post-fracture coordinator at their heart and have transformed post-fracture osteoporosis care, resulting in significantly lower re-fracture rates and substantial long-term cost savings.

Capture the Fracture campaign
Directly addressing the secondary fracture care gap, the International Osteoporosis Foundation has developed Capture the Fracture, a global campaign to facilitate the implementation of FLS for secondary fracture prevention.

“By missing the opportunity to respond to the first fracture, healthcare systems around the world are failing to prevent the second and subsequent fractures.”

Professor Kristina Åkesson (Sweden), Chair, Capture the Fracture

Studies have shown that FLS models are the most cost-effective in preventing secondary fractures. This systematic approach to secondary fracture prevention, which includes a small investment in a fracture coordinator, can result in fewer fractures and significant cost savings to the health care system.

Capture the Fracture aims to:

  • Raise awareness of FLS for preventing second fractures
  • Provide internationally endorsed standards for best practice
  • Facilitate change at a national level

Communicated through a dedicated website, www.capturethefracture.org, Capture the Fracture promotes FLS by offering best practice, recognition and resources and serves as a hub for health care providers to come together to share FLS programmes and local implementation strategies.

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Best Practice Framework

Setting the global standard of care for fracture patients, Capture the Fracture has developed the Best Practice Framework (BPF), which is a tool that defines the essential and aspirational building blocks necessary to implement a successful FLS.  The BPF can be viewed at:



Presented as a set of 13 standards, the aims of the BPF are to:

  • Empower change: the BPF empowers clinical champions and health care administrators to evaluate their health system’s service of secondary fracture prevention in the context of globally-endorsed standards.
  • Recognition and fine-tuning: the BPF offers leaders of established FLS an objective tool to identify where their service delivers optimal care – and to be recognised internationally for excellence – and opportunities to refine the delivery and scope of care that could further improve outcomes.
  • Guidance: for those health care systems that are yet to establish an FLS, the BPF describes the essential and aspirational elements of service delivery and so can inform the business planning process for new FLS in a very specific way.

“The Best Practice Framework will provide a basis for secondary prevention throughout

Europe and worldwide.”

Professor Cyrus Cooper (UK), Chair, IOF Committee of Scientific Advisors

Application process for best practice recognition

Putting the BPF into action, health care systems are encouraged to submit their FLS through the web-based questionnaire, which gathers information about the FLS and its achievements as they correspond to the framework. To date, 44 FLS have been submitted and are under review by a leading panel of experts. Applicants achieving Capture the Fracture Best Practice Recognition of Bronze, Silver or Gold will be recognized on the Capture the Fracture website’s interactive map, including the system name, location, link and programme showcase. Submit your programme here to be recognized for excellence in secondary fracture prevention: www.capturethefracture.org

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*FLS who wish to keep their achievement level confidential may remain on the map as a green marker.

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  1. Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden Arch Osteoporos 2013. Hernlund E, Svedbom A, Ivergard M, Compston J, et. al. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013 8:136 DOI 10.1007/s11657-013-0136-1.
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