Fewer fractures through better prevention

Researchers at LMU Medical Center in Munich aim to promote a new approach to secondary prevention. The approach, known as the “Fracture Liaison Service” (FLS), has already been implemented in other countries and is now being tested in Germany as part of a study funded by the Innovation Fund, led by Prof. Dr. Wolfgang Böcker of LMU Medical Center. Experts will discuss how the program is structured and how it could be implemented nationwide on Friday, March 13, at a symposium at LMU Medical Center. The goal: to jointly develop concrete and actionable strategies for comprehensive, cross-sectoral osteoporosis care.

Everyday life in German hospitals: Many people—mostly women, mostly older adults and the very elderly—are admitted with bone fractures caused by osteoporosis. In 2019, there were over 830,000 fractures. This is a failure of the bone as an organ that could have been prevented through consistent preventive medication and other measures such as exercise. Yet primary prevention is virtually nonexistent in Germany. The situation is hardly any better when it comes to secondary prevention following the first fracture.

Further figures for 2019 illustrate the impact of osteoporosis: at that time, nearly 7.7 million people in Germany were suffering from the condition. A total of 155,000 hip fractures were recorded—and the trend is on the rise. The costs associated with osteoporosis amounted to 13.8 billion euros, an increase of 4.8 billion euros compared to 2010. At the same time, the coverage gap for high-risk patients stood at 76 percent.

“Osteoporosis-related fractures are not a marginal issue, but a central healthcare challenge in an aging society,” says Wolfgang Böcker, Director of the Musculoskeletal University Center Munich (MUM)—a consortium of several departments at LMU Medical Center that collectively cover the entire spectrum of musculoskeletal medicine. Despite clear scientific evidence of the effectiveness of secondary prevention, guideline-based diagnosis and treatment of underlying osteoporosis following an initial fracture remain inadequately implemented in many cases. International approaches such as the “Fracture Liaison Service” (FLS) address this gap in care through structured, interdisciplinary treatment programs.

The transition from hospital care to outpatient care is crucial

With this in mind, experts at MUM have developed a new care model tailored to the German healthcare system. The key feature is that as soon as patients with a bone fracture are admitted and treated at the hospital, targeted diagnostic testing is automatically conducted. If osteoporosis is detected, doctors immediately initiate drug therapy to prevent further bone fractures. The concept aims to close the glaring gap in care between inpatient treatment and subsequent outpatient therapy provided by private practitioners, and to reduce both the individual burden of disease and systemic healthcare costs in the long term. “To achieve this,” says FLS coordinator Pia Kühn, “we need informed patients and widespread acceptance.”

“Our approach takes into account the reality of a group of very elderly patients, who are often multimorbid and have limited mobility, for whom access to specialist outpatient care frequently presents a significant barrier,” explains Dr Ulla Stumpf, Deputy Head of the Osteology Centre of Excellence at LMU Medical Centre. At the symposium, she will present the structure, implementation strategy and initial experiences of the approach.

“It is not a lack of knowledge,” adds Wolfgang Böcker, “but a lack of structures that often prevents modern, needs-based treatment of the underlying condition of osteoporosis. What is needed now are clear responsibilities, reliable funding and cross-sector care pathways.”