One type A service with a valid control group showed a significant decrease in re-fractures .
Types A and B services were cost-effective , although definition of cost-effectiveness varied between studies .
Fully coordinated , intensive models of care for secondary fracture prevention are more effective in improving patient outcomes than approaches involving alerts and /or education only
Most people presenting with incident osteoporotic fractures are neither assessed nor treated for osteoporosis to reduce their risk of further fractures , despite the availability of effective treatments .
We evaluated the effectiveness of published models of care for the secondary prevention of osteoporotic fractures .
Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women.
CONTEXT There are few data on long-term mortality following  osteoporotic fracture and fewer following subsequent fracture . OBJECTIVES To examine long-term mortality risk in women and men following all osteoporotic fractures  and to assess the association of subsequent fracture with that risk . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort from the Dubbo Osteoporosis Epidemiology Study of community-dwelling women and men aged 60 years and older from Dubbo , Australia , who sustained a fracture between April 1989 and May 2007 . MAIN OUTCOME MEASURES Age- and sex-specific st and ardized mortality ratios ( SMRs ) compared with the overall Dubbo population for hip , vertebral , major , and minor fractures . RESULTS In women , there were 952 low-trauma fractures followed by 461 deaths , and in men , 343 fractures were followed by 197 deaths .  Age-adjusted SMRs were increased following hip fractures ( SMRs , 2.43 [ 95 % confidence interval [ CI ] , 2.02 - 2.93 ] and 3.51 [ 95 % CI , 2.65 - 4.66 ] ) , vertebral fractures ( SMRs , 1.82 [ 95 % CI , 1.52 - 2.17 ] and 2.12 [ 95 % CI , 1.66 - 2.72 ] ) , major fractures ( SMRs , 1.65 [ 95 % CI , 1.31 - 2.08 ] and 1.70 [ 95 % CI , 1.23 - 2.36 ] ) , and minor fractures ( SMRs , 1.42 [ 95 % CI , 1.19 - 1.70 ] and 1.33 [ 95 % CI , 0.99 - 1.80 ] ) for both women and men , respectively . Mortality was increased for all ages for all fractures except minor fractures for which increased mortality was only apparent for those older than 75 years . Increased mortality risk persisted for 5 years for all fractures and up to 10 years for hip fractures . Increases in absolute mortality that were above expected , for 5 years after fracture , ranged from 1.3 to 13.2 per 100 person-years in women and from 2.7 to 22.3 per 100 person-years in men , depending on fracture type . Subsequent fracture was associated with an increased mortality hazard ratio of 1.91 ( 95 % CI , 1.54 - 2.37 ) in women and 2.99 ( 95 % CI , 2.11 - 4.24 ) in men . Mortality risk following a subsequent fracture then declined but beyond 5 years still remained higher than in the general population ( SMR , 1.41 [ 95 % CI , 1.01 - 1.97 ] and SMR , 1.78 [ 95 % CI , 0.96 - 3.31 ] for women and men , respectively ) . Predictors of mortality after any fragility fracture for both men and women included age , quadriceps weakness , and subsequent fracture but not comorbidities . Low bone mineral density , having smoked , and sway were also predictors for women and less physical activity for men . CONCLUSIONS In a sample of older women and men , all low-trauma fractures were associated with increased mortality risk for 5 to 10 years . Subsequent fracture was associated with increased mortality risk for an additional 5 years
One type A service with a valid control group showed a significant decrease in re-fractures .
Types A and B services were cost-effective , although definition of cost-effectiveness varied between studies .
Fully coordinated , intensive models of care for secondary fracture prevention are more effective in improving patient outcomes than approaches involving alerts and /or education only
Most people presenting with incident osteoporotic fractures are neither assessed nor treated for osteoporosis to reduce their risk of further fractures , despite the availability of effective treatments .
We evaluated the effectiveness of published models of care for the secondary prevention of osteoporotic fractures .