The International Osteoporosis Foundation recently announced a partnership with the University of Oxford, Amgen and UCB to combat the global public health burden of osteoporosis. We talk to Cyrus Cooper to find out more about the initiative.
SSN: Tell us a little about your background and education and your current role within the Capture the Fracture initiative?
CC: In my current role I am Professor of Musculoskeletal Science at the University of Oxford, and I’m the director of the MRC Lifecourse Epidemiology Unit at the Universities of Oxford and Southampton. I am also President of the International Osteoporosis Foundation (IOF), and was the Chair of their Scientific Committee between 2008 and 2013, prior to taking on the presidency four years ago.
I was the Founder of Capture the Fracture in 2010 when I chaired the IOF Scientific Committee. At that time we undertook a systematic review of the literature, looking at secondary fracture prevention, and found about 50 papers which documented the effectiveness of Fracture Liaison Services (what we now refer to as Post Fracture Care PFC) as part of a secondary preventive strategy against osteoporosis and fracture.
From this we incepted international guidance and set up a worldwide map of where PFCs were operating around the world. There is now something like 450 registered PFC sites worldwide.
We set up criteria for the quality of PFC, with designations of gold, silver and bronze, and each PFC that was interested in doing so could have its quality set according to this benchmark.
SSN: How did the collaboration between IOF, Amgen, UCB and the University of Oxford come about and how, together, are you aiming to reduce hip and vertebral fractures by 25 per cent, by 2025?
CC: Since the inception of Capture the Fracture, secondary fracture prevention grew sharply in the United Kingdom, a few countries in Europe, Australia, and on the west coast of the United States, as well as Canada.
We recognised that there was a huge undersupply of osteoporosis treatment: patients who had already suffered a fracture faced a much higher risk of a second fracture, something like six or seven-fold in the first few months, coming down to a doubling within 10 years afterwards. This was clearly a risk category that warranted attention.
I liken it to taking early stage preventative measures for patients with heart disease to avoid a heart attack, or providing stroke prevention strategies for someone who had a TIA.
At the early stage, Amgen and UCB were in partnership to develop new agents that promote bone formation and therefore have a marked anti-fracture effect. Such agents have a rapid onset of effectiveness, which can be used in the post-fracture period to prevent future fractures, and hold out the hope of enhancing the benefits achievable by more conventional osteoporosis therapies.
That programme, in combination with our own efforts at the IOF, and my shared research programme with Professor Javaid at the University of Oxford, led to the emergence of a comprehensive worldwide programme which aimed to reduce hip and spine fractures by around a quarter over a five year period up until 2025.
SSN: What sort of evidence have you looked at?
CC: The partnership that we refer to as the Capture the Fracture Partnership has five components.
Policy: Our aim is to provide a policy toolkit to international policy makers wherever they may be, whether in the Asia Pacific region, Latin America, Europe, North America, Oceania, or Africa and the Middle East. The policy toolkit allows them to lobby and influence policy makers to raise osteoporosis and secondary fracture prevention services higher up the policy agenda.
Coalition: Brings together key opinion leaders from patient groups, national societies, and medical and scientific representatives from around the world, to address the problem of secondary fractures.
Mentorship: We deliver a mentorship programme, spearheaded by Professor Javaid at Oxford, to enable the next generation of health leaders, physicians and surgeons to introduce quality services around the world.
Scalable solutions: We have developed a benefits calculator, which allows for a tailor-made calculation of the economic benefits of introducing a fracture liaison service.
Digital tool: Our interactive platform allows for a real time estimation of how well the PFC is performing at the patient level. It uses an anonymised, purpose-built interactive platform to track against patient and institutional KPIs.
SSN: So far, are the outcomes promising?
CC: We already have evidence of declining hip fracture rates in several parts of the world, most notably in North America, Europe and Oceania. However, rates in Southeast Asia do appear to be continuing to rise and it’s there that we’d like to see a plateau, then a subsequent fall. Once you see the outcomes, they are really set for the long term and this is clearly an initiative that is associated with built in sustainability. The secondary preventive services will still be in state health service policy programmes for a considerable period of time beyond the five years of the partnership itself.
SSN: What do you feel the outcomes may reveal in the long-term?
CC: In Oxford, we have undertaken a really rigorous evaluation of the benefits of secondary fracture prevention throughout the south central region with grant funding from the Medical Research Council and the National Institutes of Health. We looked at 14 hospitals within the Health Authority and were able to show that the inception point of a PFC was associated with a downturn in secondary fractures, and a marked increase in use of osteoporosis medication. This has been accompanied by recently presented results of a large randomised controlled trial (SCOOP) which also shows that if you risk assess and treat people who have had a fracture, you can reduce secondary fracture occurrence. The plans within the partnership are to extend this effectiveness information to really look at the health economic benefits and overall patient benefits of such secondary prevention programmes.
SSN: How do you see the future of surgery looking, especially within the field of hip and spinal surgery?
CC: Well, of course COVID-19 has transformed our approach to non-acute orthopaedic surgery, and we’re still working out the best way of delivering extremely effective interventions such as lower limb arthroplasty or spinal surgery. Access to hospital interventions has been altered, possibly irrevocably, but certainly for the medium and long term, acute trauma surgery remains available, albeit to be undertaken in different settings. We will be looking to transform approaches to those aimed at rapid healing and a combination of regenerative medicine approaches and pharmacotherapy which might give some very impressive results which could be used to treat, for example, hip fracture.
SSN: What changes are you hoping to see to improve patient experience?
CC: We’ve recently undertaken a large international survey of the impact of variability on osteoporosis services worldwide. And indeed, it has shown a number of approaches that will become an adjunct to improving the patient experience. During the COVID-19 crisis, interactive outpatient services have been a transformative component in the ability to assess risk on clinical factors, and the use of mobile risk assessment technologies, which can actually get closer to the patient, negate the need for those at COVID-19 positive sites, which become unsafe for patients to attend.
So there are a number of such aspects which have emerged in this survey that will actually continue to drive improvements in patient experience and a net improvement in quality of life.
To learn more about the global programme, please visit: www.capturethefracture.org