Global Perspectives on the Care Gap in Fragility Fracture Management

➢ 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.