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The potential of assessment based on the WHO framework of intrinsic capacity in fragility fracture prevention

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Abstract

The risk of falls associated with population ageing and the burden of chronic diseases increase the risk of fragility fractures. Globally, a large increase in the numbers of people sustaining fragility fractures is predicted. The management of highly vulnerable older persons who present and/or are at risk of fragility fractures is challenging given their clinical complexity and the fragmentation of the healthcare services. Fragility fractures frequently result in reduced functional ability and quality of life. Therefore, it is essential to implement person-centered models of care to address the individual’s priorities and needs. In this context, the multidimensional construct of intrinsic capacity, composed of the critical functions on which the individual’s functional ability rely, becomes of particular interest.

In this article, the potential of current models to meet the global challenge is considered, particularly where healthcare systems are less integrated and poorly structured. It then describes how assessment of intrinsic capacity might provide the clinician with a holistic picture of an older individual’s reserves before and after a fragility fracture and the implications of implementing this approach based on the construct of intrinsic capacity in healthcare systems, in both well-developed and low-resourced settings. It suggests that optimization of intrinsic capacity and functional ability is a credible conceptual model and might support a generally feasible approach to primary and secondary fracture prevention in older people.

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Acknowledgement

The authors are particularly grateful to Drs. Ritu Sadana, Yuka Sumi, Jotheeswaran Amuthavalli Thiyagarajan, and Anshu Banerjee (World Health Organization, Geneva, Switzerland) for their relevant and highly appreciated support in the preparation of the manuscript.

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The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Subacute Care Unit, Azienda Socio Sanitaria Territoriale (ASST) Lodi, Lodi, Italy

    Paolo Astrone

  2. Master’s and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil

    Monica Rodrigues Perracini

  3. Master’s and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil

    Monica Rodrigues Perracini

  4. Emeritus Geriatrician and Professor of Medical Gerontology, Population Health Sciences, School of Life Sciences and Population Health, King’s College London, London, UK

    Finbarr C. Martin

  5. Emeritus Professor of Orthopaedics, University College London, London, UK

    David R. Marsh

  6. Geriatric Unit, Fondazione IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy

    Matteo Cesari

  7. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari

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  1. Paolo Astrone
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Astrone, P., Perracini, M.R., Martin, F.C. et al. The potential of assessment based on the WHO framework of intrinsic capacity in fragility fracture prevention. Aging Clin Exp Res 34, 2635–2643 (2022). https://doi.org/10.1007/s40520-022-02186-w

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