A fracture isn’t just a broken bone—it’s often a wake‑up call. Especially in adults over 50, what appears as an isolated accident may signal underlying osteoporosis. If untreated, there’s a high risk of another fracture—sometimes within a year.

This makes secondary fracture prevention not just beneficial, but essential. And at the heart of this strategy? You, the GP.

1. When Should GPs Start Treatment?

  • Immediately after any fragility fracture in adults ≥ 50. All such patients—especially those with hip or vertebral injuries—should be assessed for osteoporosis and started on treatment if indicated.
  • Within the first 12 months. The highest risk of refracture is in the year post‑fracture; early medication significantly reduces the chance of recurrence.
  • Based on DXA results or FRAX scores. A T‑score ≤ −2.5, plus FRAX hip‑fracture risk > 3%, or presence of a minimal‑trauma fracture, should prompt initiation of antiosteoporosis therapy, typically a bisphosphonate.

Key takeaway: Don’t delay—investigate promptly and treat early.

2. GP Screening Guidelines in Practice

a) Who needs screening?

  • Patients aged ≥ 50 with a fragility fracture.
  • Those with risk factors like corticosteroid use, family history, early menopause, or low bone density.

b) Recommended tools & tests:

  • DXA scan for BMD assessment.
  • FRAX to evaluate 10‑year fracture risk.
  • Blood tests: calcium, vitamin D, renal function, thyroid, and sometimes bone turnover markers.

c) Interpreting results:

  • DXA T‑score ≤ −2.5 OR high FRAX risk: Start therapy.
  • Borderline BMD (T between −1.0 and −2.5): Consider individual risk; discuss treatment options.
  • Normal BMD but prior fracture: Treat anyway—the fracture itself is high‑risk.

3. Coordinated Care: GP + Orthopaedics (and FLS)

Improving outcomes requires seamless teamwork:

a) Fracture Liaison Services (FLS):

Run by hospitals or orthogeriatric teams, FLS identify fracture patients and coordinate care—educating, ordering tests, and recommending treatment.

b) Integrated care pathways:

  • Type A FLS: Initiate treatment within the FLS.
  • Type B FLS: Refer result and recommendations to GP to start treatment, easing pressure off hospital services.

c) Challenges at transition:

Studies highlight common barriers:

  • Overloaded GPs;
  • Information gaps or miscommunication;
  • Confusion over roles between FLS and GP.

d) What works in real‑world models:

  • Education plus reminders: Combined GP education and patient follow‑up significantly boost ongoing care.
  • Co‑ordinated multidisciplinary teams: Nurse‑led services working alongside primary care improve DXA uptake, treatment initiation, and medication persistence.

4. GPs: Best Practice Action Plan

  1. Identify: Ask about falls or fractures ≥ 50 years, even minor ones.
  2. Educate: Explain that a fragility fracture signals bone weakness and risk of another, and that treatment helps.
  3. Investigate: Order DXA, FRAX score, and relevant blood tests promptly.
  4. Start treatment: If indicated, begin bisphosphonate + calcium and vitamin D.
  5. Coordinate: Engage with FLS/orthopaedics—clarify roles, refer as needed.
  6. Follow‑up: Check adherence at 3, 6, and 12 months; encourage persistence—drop‑off often happens early.
  7. Long‑term monitoring: Repeat DXA every 2 years or as clinically indicated, adjust treatment plan if necessary.

5. Overcoming Barriers

  • Time pressures?

Delegate follow‑up or reviews to a nurse or GP registrar.

  • Knowledge gaps in osteoporosis?

Attend short accredited training or use FLS/FN guidelines.

  • Poor communication channels?

Ask FLS to send clear, written care plans—electronic summaries work best.

  • Medication concerns/adverse effects?

Address them early—explain risk vs benefit. Many issues (e.g., GI side effects) can be managed or mitigated.

6. Why It Matters

  • Refracture rates drop significantly—up to 50% with early treatment.
  • Quality of life improves, survival increases, and healthcare costs for hip fractures decrease.
  • Thanks to regular monitoring, patients stay on therapy longer—fewer medication drops post-FLS when primary care continues the follow‑up.

Dr Oliver Khoo’s Insight

“Many patients and even some GPs see a fracture as a one‑off injury. But in my experience, it’s often a red flag—something deeper. If we miss that, we’re missing our best chance to prevent the next fracture.”

Dr Khoo advocates for a shared‑care model: hospital‑based FLS teams initiate treatment and educate, while GPs provide ongoing monitoring, adherence support, and long-term care.

Frequently Asked Questions

Q: Isn’t it just older people?

Not always—frequent medications, chronic illness, early menopause, or low body weight can all increase risk, even at younger ages.

Q: How long should treatment continue?

Most patients stay on bisphosphonates for 5 years, then have a “drug holiday” or switch therapy depending on risk.

Q: Are there non-surgical options?

Yes! Weight‑bearing exercise, fall‑risk reduction, healthy diet, smoking cessation, and limiting alcohol all help bone health.

Is Surgery Really Necessary? Looking for a Second Opinion?

Depending on the severity of your condition and your lifestyle, surgery may be inevitable. But it’s your decision.
Let’s find out if it’s time or if other options are available, together.