JBJS - 2026-09-04 - Journal Article
Global Perspectives on the Care Gap in Fragility Fracture Management: Bridging Evidence and Clinical Practice.
Tabu I, Armstrong E, Costa ML, Frihagen F, Magaziner J, Lee JK, Sawaguchi T
Topics
Key Takeaway
Fragility fracture care gaps persist globally, with LMIC implementation failures driven by health-system constraints rather than evidence deficits, though no single quantitative outcome metric is reported in this narrative review.
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Summary
This narrative review examines the global implementation gap between evidence-based fragility fracture care standards and actual clinical practice. It identifies timely surgery, orthogeriatric co-management, early mobilization, unrestricted weight-bearing, and secondary fracture prevention as evidence-supported pillars that remain inconsistently applied, particularly in LMICs. Health-system constraints—workforce shortages, delayed presentation, limited infrastructure, fragmented pathways—are identified as the primary barriers rather than absence of evidence.
Key Limitation
The absence of a systematic search methodology and quantitative synthesis means conclusions about LMIC barriers are expert-opinion level and cannot be weighted against one another or generalized with confidence.
Original Abstract
➢ Fragility fracture care remains suboptimal worldwide despite strong evidence supporting timely surgery, orthogeriatric care, early mobilization, unrestricted weight-bearing, and secondary fracture prevention.➢ International quality standards and registry-based audits have translated this evidence into measurable indicators that improve care in many high-income health-care systems.➢ Implementation in low- and middle-income countries (LMICs) is limited primarily by health-system constraints, including workforce shortages, delayed presentation, limited infrastructure, and fragmented care pathways, rather than by lack of evidence.➢ Emerging initiatives demonstrate that evidence-based quality standards can be successfully adapted to local contexts while preserving their core clinical principles.➢ Orthopaedic surgeons have a central role in leading multidisciplinary care, promoting secondary fracture prevention, and driving quality improvement across the entire fragility fracture pathway.➢ Future progress depends on strengthening health systems, embedding auditing and certification programs, and implementing context-sensitive quality standards that bridge the gap between evidence and routine.