From fracture to action: transforming the post-fracture patient pathway in osteoporosis care

While there have been advances in the understanding and management of osteoporosis over the past decade, these have not consistently translated into meaningful improvements in patient care or outcomes in routine practice. The central challenge is no longer scientific uncertainty, but delivery. Effective therapies exist, clinical guidance is well established, and there is growing recognition of the need to personalise care, particularly for those at very high fracture risk (VHFR). Yet a substantial treatment gap remains, especially following fragility fractures. Around 50% of all patients who sustain a hip fracture have already experienced a prior fracture, underscoring a persistent and preventable missed opportunity for intervention.

Closing this gap requires a shift from guidance to action, ensuring that every fracture is recognized as a critical moment to intervene.

Clinical evidence is not translating into optimal care for osteoporosis patients

Despite the existence of clear osteoporosis guidelines, implementation remains poor because a fragility fracture is still too often treated as an isolated orthopaedic event, rather than the clearest clinical signal of underlying skeletal fragility. In practice, osteoporosis frequently falls between specialties, with no single healthcare professional consistently owning post-fracture bone health. A fragility fracture should be a simple, automatic trigger for action: assess, stratify risk and initiate an osteoporosis management plan.

Models are successfully improving the post-fracture pathway today

Coordinated post-fracture models such as fracture liaison services (FLS) have been shown to improve DEXA assessment and anti-osteoporosis treatment rates and are associated with reductions in subsequent fractures and mortality. This demonstrates that the care gap is not inevitable, but a systems problem that can be fixed.

In countries like Japan, the reimbursement for FLS has led to a significant increase in the number of patients treated following a fracture, showing the impact of prioritizing post-fracture care at a system level.

The International Osteoporosis Foundation’s Capture the Fracture® program has supported the adoption and standardization of FLS, helping to embed more structured approaches to care. At the same time, initiatives such as the Fracture Liaison Service Academy & Network (FAN), established by UCB and Amgen, are helping to translate this progress into practice. By providing practical tools, training, and peer support, FAN supports healthcare professionals in establishing and strengthening FLS in real-world settings. The focus now is on scaling these approaches consistently, ensuring that patients not only enter the pathway, but receive the right treatment at the right time.

Why a fragility fracture is a critical moment to act

A fragility fracture is the clearest marker of VHFR. However, fracture risk is not evenly distributed over time, it is front loaded, with the highest probability of a second fracture occurring in the year immediately after the first.

This period of imminent risk defines a treatment urgent population, yet our systems still delay action and apply uniform pathways. If we reframe osteoporosis using a VHFR lens, a recent fracture becomes a staging event: it signals advanced disease, urgency and the need for rapid risk reduction. Acting decisively in this window, by identifying VHFR and matching treatment intensity to risk, is how we move from documenting fractures to preventing the next one.

Bone is not a static organ; it is dynamic and responsive to treatment. With timely and appropriate intervention, there is an opportunity to reduce future fracture risk and change the trajectory for patients.

Improving care for patients at VHFR

The next step is to reframe osteoporosis with the help of advances in digital tools and AI that will raise the standard of care by shifting practice from reactive, generic management to proactive, individualized care. By integrating fracture risk stratification, advanced imaging diagnostics and decision support into routine care, care can be tailored to an individual's fracture risk profile, comorbidities, functional status and treatment history, supporting delivery of the right therapy at the right time and in the right sequence. At the same time, digital coordination across services, patient-facing tools and remote monitoring may improve adherence to ensure that personalised treatment decisions translate into better long-term outcomes.

Over the next one to two years, these developments are likely to significantly improve how we identify patients at VHFR. The priority will be to ensure that this identification leads directly to action.

The focus now is turning progress into practice, ensuring that every fracture becomes a moment to act.

Let’s help create a world from fragility fractures. Learn more at Fragility Fractures in Focus on YouTube.