Secondary fracture prevention and osteoporosis within the context of the WHO Decade of Healthy Ageing

Cyrus Cooper

Secondary fracture prevention and osteoporosis within the context of the WHO Decade of Healthy Ageing

The World Health Organization (WHO) Decade of Healthy Ageing 2020–2030 is shining a spotlight on the critical importance of ensuring good health and quality of life for our increasingly ageing populations.1 The WHO recognises that healthy ageing relies on maintaining the functional ability which underpins the wellbeing of individuals as they get older. Functional ability itself is determined by people’s physical and psychological capacities, along with their environment.1

Osteoporosis is the most common bone disorder worldwide, affecting 21% of women and 6% of men aged 50–84 in Europe. Osteoporosis reduces bone mineral density, weakening bones and leaving them at risk of fragility fractures, which have a significant impact on functional ability and quality of life.2 3

After age and gender,4 one of the biggest risk factors for a fragility fracture is a previous fracture.5 Fracture risk rises for the rest of a person’s lifetime after their first fracture, and this rise is particularly steep for the first 1–2 years post-fracture.5 This increased risk of ‘imminent fracture’ provides a crucial window during which preventive strategies must be employed. Thus, secondary fracture prevention – which involves identifying people as they have their first fracture, evaluating their risk, and working to reduce the risk of a second fracture – is critical.

Strategic fracture prevention

There are many models for secondary fracture prevention, the most widely known being a fracture liaison service (FLS). These multidisciplinary models of care are proven to be both effective and cost-effective.6 The International Osteoporosis Foundation has been coordinating an effort to identify and evaluate FLS around the world through our initiative called Capture the Fracture.7 8 We have now assessed over 400 FLS worldwide against our three grades (gold, silver and bronze).9

Moving forward, our objective is to double provision of these FLS in order to achieve a 25% reduction in secondary fractures worldwide.10 The Capture the Fracture Partnership was established in mid-2020 to realise these goals.10 In its first two years, our programme will work on secondary fracture prevention through policy, coalition mentorship, scalable solutions and an even more sophisticated database for FLS worldwide to generate their own performance metrics.10

Ageing with quality of life

As Europe’s populations live longer, it is crucial that we harness the WHO Decade of Healthy Ageing and take all the measures needed to ensure older people maintain their functional ability by having the opportunity to live their lives in good physical and psychological health. Preventing osteoporosis and the fractures that they can cause is a crucial activity in achieving this aim. By preventing fractures we can prevent the disability they cause and the impact they have on people’s physical and mental wellbeing.

Many other non-communicable diseases have clear pathways of prevention and treatment. The connection between low bone mineral density and fragility fractures is analogous to the connection between cholesterol and strokes, or blood pressure and heart attacks. However, secondary fracture prevention efforts in bone health lag behind efforts to prevent these other events. The assessment of risk for osteoporosis and fragility fractures is simply not on the same level, and this gap must be addressed if we are to achieve our objectives of supporting our older populations to age in good health and with a high quality of life.


Cyrus Cooper is a member of the Osteoporosis and Fragility Fracture Policy Network’s Expert Advisory Group. He is President of the International Osteoporosis Foundation; Professor of Rheumatology and Director at MRC Lifecourse Epidemiology Unit; Vice-Dean of Medicine at the University of Southampton; and Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK

This blog post reflects the opinions of the author and does not represent the views of other Network members, nor those of Amgen. References are provided for the data and statistics cited in this blog post but all other information is given as the opinion of the author.
Date of preparation: March 2021    Hub-PRO-1220-00008
References +
  1. World Health Organisation. 2020. Decade of Healthy Ageing 2020-2030. Geneva: WHO
  2. Hernlund E, Svedbom A, Ivergard M, et al. 2013. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Archives of osteoporosis 8: 136
  3. Salkeld G, Cameron ID, Cumming RG, et al. 2000. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ (Clinical research ed) 320(7231): 341-6
  4. Hannan MT, Felson DT, Dawson-Hughes B, et al. 2000. Risk Factors for Longitudinal Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study. Journal of Bone and Mineral Research 15(4): 710-20
  5. Johansson H, Siggeirsdóttir K, Harvey NC, et al. 2017. Imminent risk of fracture after fracture. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 28(3): 775-80
  6. Leal J, Gray AM, Hawley S, et al. 2017. Cost-Effectiveness of Orthogeriatric and Fracture Liaison Service Models of Care for Hip Fracture Patients: A Population-Based Study. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 32(2): 203-11
  7. Capture the Fracture. Home page. Available from: [Accessed 23/11/20]
  8. International Osteoporosis Foundation. Home page. Available from: [Accessed 06/10/20]
  9. Capture the Fracture. Map of Best Practice. Available from: [Accessed 01/09/20]
  10. Capture the Fracture. Capture the Fracture Partnership. Available from: [Accessed 23/11/20]