secondary fracture prevention coalition in Mexico

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First meeting of the Mexican Coalition for Secondary Fracture Prevention identifies challenges and opportunities for the implementation of timely care programmes, and improvement of the quality of care for people with fragility fractures at all three levels of health care nationwide.

In Mexico, the prevalence of musculoskeletal disorders among people aged 60 years and older is 36.4%. Hip fracture is one of the most serious complications of osteoporosis, with considerable repercussions on quality of life, morbidity and mortality. In 2019, the Mexican Social Security Institute (IMSS) reported that 11,615 hip fractures occurred in those over 65 years of age, representing a rate of 176 fractures per 100 000 inhabitants in the entire population. Mortality after a hip fracture can reach 10% during the hospital stay and 30% within the following 12 months. After the fracture, 25% of individuals require care in a specialized institution while those who survive do not recover their pre-fracture quality of life.

The Capture The Fracture® (CTF) program is an International Osteoporosis Foundation (IOF) initiative that facilitates the implementation of Post Fracture Care (PFC/FLS) programs for secondary fracture prevention. As of March 2023, the CTF International Map of Best Practice includes 822 FLS in 54 countries, including 32 FLS in Mexico

The Mexican Coalition for Secondary Fracture Prevention has been established with the goal of building a national alliance to foster the adoption of PFC/FLS programmes and reduce the burden of osteoporosis and fragility fractures in Mexico.

The Coalition met for the first time on October 26th, 2022 in Mexico City and brought together representatives of ten renowned Mexican institutions from the public, private and civil society sectors, including the National Institute of Geriatrics, the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra (INR), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Facultad de Medicina de la UNAM, Programa GeriatrIMSS del Instituto Mexicano del Seguro Social, Colegio Mexicano de Ortopedia y Traumatología (CMO), Colegio Mexicano de Reumatología, Colegio Nacional de Medicina Geriátrica (CONAMEGER), and the Academia Mexicana de Geriatría and the Asociación Mexicana de Metabolismo Óseo y Mineral (AMMOM).

Dr. Philippe Halbout, CEO of IOF, present during the meeting, opened the session and proposed a collaborative framework in which participants committed to work to:
•    Promote dialogue with policymakers and government officials to drive policy change
•    Foster communication at the national level
•    Encourage and support the training of medical professionals
•    Develop and improve the quality of PFC/FLS programs
•    Enhance the patient's clinical pathway

The meeting provided an opportunity to discuss the challenges and opportunities around secondary fracture prevention. One of the main challenges addressed is the identification and training of professionals involved in the care of patients with fragility fractures. Training should include specialists as well as young professionals and other non-specialist health professionals. Universities can play a key role in this aspect. Dr. Melissa Islas, from UNAM, pointed out that "It would be interesting to have a clinical pathway with a multispecialist perspective from the beginning. In the case of UNAM, for example, in addition to the curricula for all medical specialties, the university also includes a nursing school, and a nutrition curriculum, among others." In this regard, IOF has formalized a collaboration plan with the UNAM School of Medicine, which has recently joined as a member of the IOF University Network.  Dr. Alfredo A. Reza Albarrán of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán emphasized the need to consider primary prevention within the coalition's actions “because general practitioners are, in most cases, the first to receive the fractured patient, and are key actors to avoid the costs of osteoporosis and fractures for both the patient and the health system."

Undoubtedly, the complexity of the Mexican healthcare system imposes the need to adapt the available resources to each type of healthcare model, and this was another topic discussed at the meeting. It is necessary to work on actions that guarantee timely and adequate access to treatment for osteoporosis and fragility fractures in both the public and private systems. In the case of the institutions of the Ministry of Health system whose hospitals serve the population that is not covered by the social security system and cannot afford private medical insurance, there is a significant gap between the prescription of treatment and patient follow-up. Dr. Roberto Coronado of the INR, stressed that "the possibility of providing the tools and empowering other health professionals, such as nurses, to provide patient follow-up as a member of an FLS team may be one of the keys to closing this gap." 

In this regard, it is also worth highlighting the networking that the Mexican Association of Bone and Mineral Metabolism (AMMOM), a full member of the IOF, is doing to close the osteoporosis care gap. Its president, Dr. José Francisco Torres Naranjo, said, "the agreement we signed last August with more than a dozen national and international organizations is a major step towards secondary prevention of fragility fractures at the national level."

The need for a multidisciplinary approach to patients with fractures in orthogeriatrics units was also raised. In this regard, Dr. Humberto Medina, head of the Clinical Excellence Division of the IMMS Medical Benefits Direction, mentioned the progress of the recent collaboration between IOF and GeriatrIMSS, saying: "The environment of functional orthogeriatrics units will allow a comprehensive and systematic approach to patients with fragility fractures and osteoporosis. It is necessary to adapt it to the resources available in each hospital, according to the level of care.” The Mexican College of Orthopaedics and Traumatology (CMO), also expressed its commitment to promote this model of care among the orthopaedic community.

Finally, the tools and resources, both ongoing and in development, that influence the sustainability of FLSs in Mexico were discussed. This is the case, for example, of the Mexican National Standard, still in the process of being sanctioned, which is expected to help manage existing medical resources at all levels of care and improve the diagnosis of patients with frailty. 

During the meeting, the importance of unifying information systems was also emphasized to facilitate informed decision-making on health policies. In this regard, IOF presented the initial results of the Mexican Benefit Calculator based on information provided by the IMSS. Dr. Halbout stated: “The Benefit Calculator is a valuable tool that will be adapted to the different health systems in Mexico and will be a key resource to engage policymakers, the key decision makers.”

The National Coalition for Secondary Fracture Prevention represents a remarkable advance in national efforts to raise awareness about osteoporosis and its consequences, for the disease to be prioritized on the public health agenda, thus contributing to a fracture-free, active and healthy aging for the Mexican population.