Fragility fracture special issue: call for papers.


In 2008 Nobo Komagata broke his hip. In his blog about his experiences (Komagata 2008) he tells us: “I thought that the fracture would heal in three months and that I would be able to resumemy normal life after that. But it was not at all like that. I had to go through a lot more than I anticipated in terms of treatment and also psychologically.[. . .] Once I regained the mobility, it’s easy to forget what I went through. However, I often look back and feel that even the ability to walk is such a great gift. I once accepted the possibility of not being able to walk on my own for the rest of my life. As I can walk again, I should use the gift appropriately”. There are several different types of fractures sustained due to bone fragility, but hip fracture is perceived to have the most lasting impact on the lives of individuals. Not everyone is able to walk on their own again after hip fracture – a much feared cause of loss of mobility and independence for older people. In developing countries people frequently die or become disabled following road traffic trauma. In developed countries death or loss of independencemore frequently occurs following fragility fracture. As global societies progress, this may become more balanced – bone fragility is associated with social conditions and lifestyle in wealthier nations and the link between fracture and osteoporosis is more pronounced in the developed nations in the northern hemisphere – for now. At a global level, the figures are already staggering. A fragility fracture is estimated to occur every 3 seconds. This amounts to 25,000 fractures per day or 9 million per year. The financial costs are also immense; 32 billion EUR per year in Europe and 20 billion USD in the United States. The potential burden imposed on growing economies is another source of concern. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050. Similar projections are being made for other parts of the world where there are ageing populations and increasingly sedentary lifestyles as social conditions change (International Osteoporosis Foundation, 2016). Fragility fractures are predictable – we know what causes them and we know, at least to some degree, how to prevent them. However, unlike many other serious health problems such as cardiovascular disease and cancer, the incidence of osteoporosis is not decreasing and neither is the rate of falls in older people. Hence, fragility fracture is one of the foremost challenges for health care providers, commissioners and funders in all parts of the world as 2020 and 2050 rapidly approach. Just as we advise patients against smoking or obesity, there is a need to mobilise all health care workers, health organisations and governments to address bone health, falls and fractures. The impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. Those wrist, arm and spinal fractures seen every day are warning signs that a hip fracture may just be a matter of time. Prevention of bone fragility has to be the starting point – beginning by working with families, schools and children’s services to ensure that children and young people reach their peak potential bone mass before depletion begins in adulthood. This may well be the toughest challenge of all. The factors that affect bone mass in childhood and early adulthood are complex and include numerous hormonal, hereditary and lifestyle influences. One of the most pressing problems is that children and young people, International Journal of Orthopaedic and Trauma Nursing (2016) ■■, ■■–■■ ARTICLE IN PRESS


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