· Executive Brief
World Osteoporosis Day 2026
Move from isolated campaign activity to one connected operating plan across internal and community partners.
Leadership signal
Use World Osteoporosis Day to examine the system behind the message.
A public-facing observance can involve communications, operations, service lines, community partners, and leadership. Before publishing activity, align the message with real routes, available support, ownership, escalation, and the method used to answer questions that the campaign may generate.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
A fragility fracture is a handoff, not an endpoint
A fragility fracture is often the first clear signal that a person’s bone health needs attention. What happens next depends on whether the health system treats that signal as a handoff or as the end of an episode. In a Manitoba registry of 88,696 adults undergoing a first bone density test, 21,105 (23.8%) already had a prior fracture.[10] Prior fracture was associated with higher later fracture risk, with adjusted hazard ratios from 1.51 to 2.12 across age groups.[10]
The consequences extend well beyond the orthopedic stay. Among 1,756,388 Medicare beneficiaries hospitalized for hip fracture, 29.2% had dementia.[3] One-year survivors with dementia spent 53.9 fewer days at home than survivors without dementia.[3] In the same cohort, patients with dementia died 50.3 days earlier.[3] That burden shifts quickly to skilled nursing facilities, long-term care and families.
Effective secondary prevention already exists. A systematic review of 37 studies, 22 of them meta-analyzed, found lower subsequent fracture risk with fracture liaison services, with a pooled risk ratio of 0.68 at two years or more.[12] Yet treatment after hip fracture remains uneven. In a Danish cohort of 57,887 older adults, only 20.8% of those without a mental disorder started osteoporosis medication within a year.[4]
That gap is an operating problem that executives can own. The service works when it reaches people, but too many patients leave the fracture episode without evaluation, treatment or a confirmed follow-up owner. The failure points sit between departments, payers and care settings rather than inside any single clinic.
World Osteoporosis Day is a useful moment to ask where the pathway leaks. The sections below summarize peer-reviewed evidence on burden, screening, transitions, access, equity, workforce and communication. They sit beside the executive guidance already on this page and give boards and operating leaders a shared factual base for choosing where to act first.
Current evidence
What current research shows about risk, screening and treatment gaps
Screening tools do not reliably find everyone at risk. In 6,067 women aged 50 to 64 from a bone density substudy at three centers, 14.1% had osteoporosis at any site.[8] Three recommended risk tools showed only fair to moderate discrimination, with areas under the curve of 0.633, 0.663 and 0.654.[8] The authors described a gap in identifying younger postmenopausal women from clinical risk factors alone.[8] The study used data collected from 1993 to 1998, so current populations may differ.[8]
Prior fracture is a clearer signal, and it often arrives before testing does. In the Manitoba registry, adults were followed for a mean of 9.0 years after their first bone density test.[10] The cohort was 90.3% female, with a mean age of 64.6 years.[10] Those with an earlier fracture had higher risk of a later osteoporotic fracture across the age groups examined.[10] For health systems, the fracture encounter itself is the most dependable screening opportunity, because the patient is already in care.
Fracture liaison services turn that signal into action. The meta-analysis reported a pooled risk ratio of 0.26 at one year, rated low certainty, and 0.68 at two years or more, rated moderate certainty.[12] Of its 37 studies, 34 (91.9%) were judged at low risk of bias.[12] In Norway, a stepped-wedge cluster-randomized study of 100,198 women and men found lower subsequent fragility fracture risk after services began.[9] Hazard ratios were 0.87 for women and 0.90 for men, and mortality hazard ratios were 0.82 and 0.85.[9] Those figures correspond to 13% and 10% lower fracture risk and 18% and 15% lower mortality.[9]
The financial case is also documented. A systematic review of 23 fracture liaison services reported a mean return on investment of 10.49, with a median of 7.57.[13] Of those services, 86.96% showed a positive return.[13] Services that made treatment recommendations had the highest mean return, at 18.39.[13] The review also found strong monetary return for services focused on specific fracture sites.[13]
Even so, treatment after fracture remains low in many settings. In the Danish hip fracture cohort, one-year initiation ranged from 20.8% among patients without a mental disorder to 6.5% among those with an organic mental disorder.[4] The authors concluded that initiation after hip fracture remains suboptimal.[4] The evidence says the intervention works, but the delivery system does not reach enough people. That distinction matters for boards, because the remedy is operational rather than scientific.
Figure 1
Proven services, uneven reach after fracture
Percent of patients, as reported in each study (treatment initiation, operative fixation or nonattendance). Values are copied from the cited studies [4], [5], [14]; none is estimated.
Data note. These values come from different studies, countries, populations and measures, so this is an indirect comparison; the bars show where post-fracture care leaks, not how one setting compares with another.
Limitation. Each value reflects its own setting and denominator; the nonattendance figure is from one institution, and the fixation figures describe surgical treatment rather than secondary prevention.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Started osteoporosis medication within 1 year of hip fracture, no mental disorder | 20.8% | Danish registries, 57,887 patients aged 65 and older with first hip fracture, 2010 to 2020 | [4] |
| Started osteoporosis medication within 1 year of hip fracture, organic mental disorder | 6.5% | Same Danish cohort, patients with an organic mental disorder | [4] |
| Did not attend hip fracture liaison follow-up | 68% | Single-institution hip fracture liaison initiative; only 7 patients started antiresorptive therapy | [5] |
| Operative fixation of distal radius fracture, Black patients | 20.2% | 26,874 patients aged 57 to 72 in three U.S. states, 2016 to 2019 | [14] |
| Operative fixation of distal radius fracture, White patients | 35.4% | Same three-state cohort, White patients | [14] |
Continuum of care
Where post-fracture care breaks between hospital, clinic and home
The weakest link is often the move from the inpatient stay to outpatient follow-up. At one hip fracture liaison program, nonattendance reached 68%, and only 7 patients started antiresorptive therapy.[5] The authors called nonattendance a critical and underappreciated barrier to program success.[5] They reviewed the multifactorial reasons for nonattendance and proposed targeted strategies to address them.[5] A service that identifies patients but loses them after discharge has not closed the gap. Nonattendance should be reported as a core quality measure, not treated as a scheduling detail.
Handoffs to primary care carry their own risks. A qualitative evaluation of an academic fracture liaison service with embedded clinical pharmacists drew on 22 interviews and identified six themes.[1] Clinicians valued the service for finding patients whose new osteoporosis diagnosis might have been overlooked or left untreated.[1] They also reported workflow inconsistencies and systemic delays in obtaining laboratory results and bone density scans.[1] Some medically complex patients were not well suited to the service.[1]
Pharmacist-led home medicines reviews offer one bridge between hospital and community care. An Australian study nested in a randomized trial drew on 56 interviews with pharmacists, liaison clinicians, general practitioners and patients between September 2022 and January 2024.[7] Patient and general practitioner engagement shaped whether reviews worked.[7] Hospital endorsement of review reports and general practitioner confidence in deprescribing also mattered.[7] The model places a clinician in the patient’s home, where the hospital’s plan meets daily life.
Transitions after hip fracture also shape where people live. In the Medicare cohort, patients with dementia spent 52.5 days in long-term care, compared with 12.4 days for those without dementia.[3] They also spent 38.2 days in skilled nursing facilities, compared with 24.2 days.[3] Medicaid eligibility, rural residence, region and age 85 or older were associated with the fewest days at home.[3] Bone health follow-up therefore has to travel with the patient into skilled nursing, long-term care and home settings.
For leaders, the continuum question is simple to state and hard to answer. Who owns the patient’s bone health on the day after discharge, and how would anyone know if that owner never received the handoff? Most organizations cannot yet answer both parts with data. The answer usually requires a shared worklist, an acknowledged receiver and a visible status for every patient who has not been seen.
Figure 3
Why the pathway breaks
People
- No dedicated coordinator for outreach and rescheduling
- Unclear roles between liaison team, pharmacists and primary care
- Limited general practitioner confidence with medication decisions
Process
- No inpatient evaluation before discharge
- Follow-up depends on patients returning on their own
- Workflow inconsistencies across referral steps
Technology
- Delays in obtaining laboratory results and bone density scans
- Weak communication systems between liaison team and primary care
- Limited telehealth access for remote patients
Environment
- Discharge to skilled nursing or long-term care
- Rural residence and distance from clinics
- Family caregiving pressures and age stereotypes
Policy
- Payment that rewards in-hospital process but not follow-through
- No remuneration for pharmacist medication reviews
- Coverage that does not close racial and ethnic gaps
Measurement
- Treatment initiation not tracked after discharge
- Measures not stratified by language, race, dementia or mental health
- Nonattendance not reported to leadership
Unranked qualitative cause-and-effect diagram for the outcome in the box: Patients with a fragility fracture leave the episode without bone health evaluation, treatment or a confirmed follow-up owner Causes are assembled from the cited literature [1], [2], [3], [4], [5], [6], [7], [11], [14]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | No dedicated coordinator for outreach and rescheduling; Unclear roles between liaison team, pharmacists and primary care; Limited general practitioner confidence with medication decisions |
| Process | No inpatient evaluation before discharge; Follow-up depends on patients returning on their own; Workflow inconsistencies across referral steps |
| Technology | Delays in obtaining laboratory results and bone density scans; Weak communication systems between liaison team and primary care; Limited telehealth access for remote patients |
| Environment | Discharge to skilled nursing or long-term care; Rural residence and distance from clinics; Family caregiving pressures and age stereotypes |
| Policy | Payment that rewards in-hospital process but not follow-through; No remuneration for pharmacist medication reviews; Coverage that does not close racial and ethnic gaps |
| Measurement | Treatment initiation not tracked after discharge; Measures not stratified by language, race, dementia or mental health; Nonattendance not reported to leadership |
Access
Access depends on the route, not only the diagnosis
Access is not only about whether a service exists. It depends on whether patients are identified, referred, scheduled and reached. The Danish cohort found that initiation was higher among patients under 80, women, those with previous fractures, those with less comorbidity and those living with someone in their own home.[4] Initiation was also higher in more recent years.[4] Each pattern points to a route that works better for some patients than for others. Leaders should ask which differences reflect clinical judgment and which reflect a route that quietly excludes people.
Mental health is one of the clearest access gaps. One-year initiation was 11.5% for patients with schizophrenic disorders, 14.8% for mood disorders and 16.1% for anxiety disorders.[4] It was 17.0% for patients with substance use disorders.[4] Each was below the 20.8% seen in patients without a mental disorder.[4] Fracture services rarely coordinate with behavioral health, yet these patients may need more structured follow-up and a named contact.
National policy can widen access to the first steps of prevention. Japan introduced a reimbursement scheme for secondary fracture prevention after hip fracture in 2022.[2] In an interrupted time series of 127,676 patients aged 60 or older, the fee was associated with substantial and sustained increases in in-hospital assessment and medication initiation.[2] Process measures included osteoporosis assessment, initiation of guideline-recommended medication and receipt of both during the index hospitalization.[2] However, there was no clear national change in secondary fractures within six months.[2]
The Japanese findings suggest that payment alone is not enough. A greater post-introduction decline in secondary fractures was seen in hospitals paid under the Diagnosis Procedure Combination system than in other hospitals.[2] The authors suggested that organizational capacity and established care pathways may influence how incentives translate into benefit.[2] Executives weighing new payment models should fund the pathway, not only the billing code. They should also track outcomes after discharge, since in-hospital process gains may not show up as fewer fractures.
Value evidence can support that investment. Liaison services that incorporated primary care providers had a mean return on investment of 16.04.[13] Intensive models, classified as type A and B, showed higher returns than less intensive type C and D models.[13] A service designed to reach patients after discharge is therefore both an access decision and a financial one. Finance and clinical leaders should model it together rather than in separate budget cycles.
Executive guidance · System route
Connect the day to an accountable system route.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Define the purpose
- Align the entry point
- Coordinate the partner route
- Manage response
- Review the campaign
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Define the purpose
Name the audience, intended action, approved message, and limits of what the campaign can responsibly promise.
Align the entry point
Connect every communication channel to current information and a clearly identified receiving role or team.
Coordinate the partner route
Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal.
Manage response
Keep questions, referrals, exceptions, and unresolved work visible until an accountable receiver accepts them.
Review the campaign
Compare intended action with local process signals and partner feedback, then document the improvement to carry forward.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Define the purpose | Name the audience, intended action, approved message, and limits of what the campaign can responsibly promise. |
| Align the entry point | Connect every communication channel to current information and a clearly identified receiving role or team. |
| Coordinate the partner route | Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal. |
| Manage response | Keep questions, referrals, exceptions, and unresolved work visible until an accountable receiver accepts them. |
| Review the campaign | Compare intended action with local process signals and partner feedback, then document the improvement to carry forward. |
Equity and trust
Equity gaps appear across race, ethnicity, language and mental health
Disparities in fracture care appear early and persist. A study in Florida, Maryland and New York examined 26,874 adults aged 57 to 72 with distal radius fracture between 2016 and 2019.[14] Overall, 32.6% had operative fixation.[14] Fixation was performed in 20.2% of Black patients and 25.8% of Hispanic patients, compared with 35.4% of White patients.[14] Adjusted odds ratios were 0.60 for Black patients and 0.82 for Hispanic patients.[14]
Insurance coverage alone did not close those gaps. The authors found that Medicare eligibility at age 65 did not attenuate race and ethnicity-based disparities.[14] The study compared adults on both sides of the Medicare eligibility age.[14] The finding suggests that the drivers sit partly in referral patterns, decision-making and system design. Leaders cannot assume that coverage expansion will equalize care without changes to the pathway itself.
Language is another fault line. In an Ontario cohort of 35,238 older adults who had hip fracture surgery between 2017 and 2022, 6,423 (18.2%) had a non-English language preference.[11] Median surgical wait time was similar, at 24 hours for English speakers and 25 hours for others.[11] Delirium, however, occurred in 18.8% of patients with a non-English preference, compared with 14.6% of English speakers.[11] Myocardial infarction was also more frequent, at 0.7% versus 0.5%.[11]
Patients with a non-English preference also had longer stays, with a median of 11 versus 10 days.[11] They were discharged to a nursing home more often, at 7.0% versus 6.8%, with an adjusted relative risk of 1.13.[11] The authors described these results as inequities in hip fracture care.[11] Because surgical timing was similar, the differences point toward what happens around the operation, including communication and recovery support.
Equity also includes cognitive and mental health status. Patients with mental disorders started treatment less often after hip fracture, and patients with dementia spent fewer days at home.[4][3] Stratifying every post-fracture measure by race, ethnicity, language, cognition and mental health is the first step toward seeing these gaps locally. Mental health and dementia status are rarely part of equity dashboards, yet both studies show they matter. Trust grows when communities can see that leaders measure these gaps, explain them and act on them.
Human infrastructure
The coordinator, the pharmacist and the primary care partner
Fracture liaison services depend on people more than on technology. The value review found that service design shaped return, and services led by primary care providers had a mean return on investment of 12.07.[13] Primary care involvement also appeared among the highest-return designs, which places the community clinician inside the core team.[13] Who leads the service, and how it connects to primary care, is a staffing decision with financial consequences. It deserves the same scrutiny as any other service line investment.
Pharmacists are an underused part of that workforce. In the Australian study, 25 pharmacists, 14 liaison clinicians, 7 general practitioners and 10 patients described what made home medicines reviews work.[7] Enablers included embedded administrative assistants, role clarity and a mobile pharmacist network.[7] Appropriate remuneration, reliable scheduling and communication systems were also identified.[7] The researchers used an established implementation framework to organize these factors.[7]
In the academic service, embedded clinical pharmacists supported centralized outreach to patients with new fractures.[1] Primary care providers recognized the program’s value and said it made osteoporosis easier to address.[1] The service also provided education for patients and primary care providers.[1] Workflow inconsistencies and delays in obtaining bone density scans were among the challenges they described.[1] Providers asked for more timely communication with the delivery team, clearer documentation and further disease state education.[1]
Workforce design also has to fit the population served. Participants in the Australian study identified access to telehealth services as a factor in implementation.[7] In the Medicare cohort, rural residence was associated with fewer days at home after hip fracture.[3] Rural and homebound patients may need outreach that does not depend on a clinic visit. Home visits, telehealth and community pharmacy partnerships can extend a small central team. Each option needs a named owner, protected time and a way to report back to the liaison service.
Executives should treat outreach capacity as part of the intervention. The 68% nonattendance seen at one hip fracture program shows what happens when follow-up depends on patients returning on their own.[5] Coordinator time for reminders, rescheduling and tracking is core capacity, not administrative overhead. When that time is cut, the service may still look active while its reach quietly shrinks. Leaders should review coordinator caseloads with the same regularity they apply to nurse staffing.
Executive guidance · Operating dashboard
Review reliability, not campaign activity alone.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Message alignment
Do channels and partners communicate one current and appropriately bounded route?
- Candidate local measure
- Content review status, conflicting instructions, corrections, and unresolved questions.
Executive guidance · Signal
Response ownership
Does every campaign-generated request reach an accountable receiver?
- Candidate local measure
- Routing, acknowledgment, repeat contact, unresolved work, and escalation signals.
Executive guidance · Signal
Partner-route reliability
Do participating teams share one current route and understand who owns each dependency?
- Candidate local measure
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Executive guidance · Signal
Action closure
Did leaders complete and verify the improvement selected for the campaign window?
- Candidate local measure
- Assigned action, status, evidence of completion, and post-action review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Message alignment | Executive sponsor and operational lead |
| Response ownership | Operational owner and participating teams |
| Partner-route reliability | Sending and receiving owners |
| Action closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Transfer responsibility with acknowledgment and visibility.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Name the sending and receiving owners, shared information, current status, and unresolved dependency.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Connect operating signals to accountable executive review.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Message alignment | Do channels and partners communicate one current and appropriately bounded route? | Executive sponsor and operational lead | At campaign launch and close |
| Response ownership | Does every campaign-generated request reach an accountable receiver? | Operational owner and participating teams | At a locally defined cadence |
| Partner-route reliability | Do participating teams share one current route and understand who owns each dependency? | Sending and receiving owners | At a locally defined cadence |
| Action closure | Did leaders complete and verify the improvement selected for the campaign window? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable post-fracture pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Every fragility fracture in adults aged 50 and older is identified during the index encounter | Patients leave without bone health evaluation | Orthopedic service line leader with fracture liaison coordinator | Share of eligible fractures captured on a liaison worklist within the admission or visit |
| Inpatient bone health evaluation before discharge | Evaluation depends on a later clinic visit that many patients miss | Hospital medicine and orthopedic medical directors | Share of admitted fragility fracture patients evaluated before discharge |
| Confirmed follow-up owner after discharge, including post-acute settings | Patients in skilled nursing, long-term care or rural homes lose bone health follow-up | Care transitions director and post-acute network lead | Share of discharges with a named receiving clinician who acknowledged the handoff |
| Active outreach for missed follow-up | Nonattendance goes undetected | Fracture liaison coordinator | Missed-visit rate and time from missed visit to outreach |
| Pharmacist and primary care medication review | Treatment is never started or is stopped without review | Pharmacy director and primary care medical director | Share of patients with a documented treatment decision within one year |
| Language access and stratified reporting | Disparities by language, race, dementia and mental health stay invisible | Chief health equity officer and quality lead | Quarterly measures stratified by language preference, race, ethnicity, cognition and mental health |
Control points derived from the cited evidence [1], [3], [4], [5], [7], [11], [13] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Public messages must lead to a route that works
Awareness campaigns can change what people know. In a 30-day health communication campaign for rural women aged 60 to 75 in Iran, 98 women received the intervention and 103 served as controls.[15] Knowledge and attitude scores were higher in the intervention group afterward.[15] Practice, however, did not differ significantly between groups (P=0.569).[15] Within the intervention group, knowledge, attitude and practice scores all rose.[15]
That pattern matters on World Osteoporosis Day. A message can raise awareness without changing behavior when the next step is unclear or hard to reach. The campaign result suggests that public messages need a linked route to evaluation, testing or follow-up.[15] Before launch, communications and operations leaders should confirm that every call to action connects to a staffed, reachable service.
Patient beliefs also shape follow-through. A qualitative study of 20 older patients with subsequent fractures and 10 family caregivers in Beijing identified three themes.[6] These were internalized negative age stereotypes, attitude-driven gaps in osteoporosis management and family caregiving challenges.[6] Negative age stereotypes reduced behavioral autonomy and lowered expectations of benefit.[6] The effectiveness of family caregiving varied with cognition, beliefs and cultural identity.[6] The authors recommended proactive health education and stronger community support for family caregivers.[6]
Communication has to work across languages. The Ontario study opened by noting that patients with a non-English language preference face adverse events that may be associated with communication barriers.[11] The same cohort found more delirium and longer stays among these patients, so language support is a safety issue as well as a courtesy.[11] Interpreter access, translated materials and teach-back belong inside the fracture pathway, not only in the campaign. Messages should also speak to families, who often carry follow-up after discharge.
Clinicians need clear communication too. Primary care providers in the academic service asked for more timely updates from the liaison team and clearer documentation.[1] That service already provided education for patients and providers, which a public campaign can reinforce.[1] A public message about bone health is credible only when the clinicians receiving follow-up know what is expected of them. Internal briefings for primary care, pharmacy and post-acute partners should precede any public campaign.
Executive guidance · 90-day plan
Use 90 days to correct one visible operating barrier.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how World Osteoporosis Day communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how World Osteoporosis Day communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Pair recognition with a system people can trust.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Connect the message to one usable, measured, and sustained operating change.
Executive action kit · Day observance
Turn World Osteoporosis Day into accountable action.
Move from isolated campaign activity to one connected operating plan across internal and community partners.
Leadership focus
Use this observance to examine trustworthy information, prevention access, and community connection. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, access, coordination, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review language, disability, transportation, digital access, geography, trust, and other barriers using protected feedback and locally appropriate data.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, frontline teams, operational leaders, and community partners. Find one a message, request, referral, or handoff that does not reach an accountable owner, then test the locally approved route from entry through acknowledged follow-through.
- Define the purpose
- Align the entry point
- Coordinate the partner route
- Manage response
- Review the campaign
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Content review status, conflicting instructions, corrections, and unresolved questions.
- Routing, acknowledgment, repeat contact, unresolved work, and escalation signals.
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Public Health and Community Partners
Staff communication template
During World Osteoporosis Day, our organization will connect awareness with a practical review of the information, access, coordination, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
World Osteoporosis Day is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Bauguess HD, Hoang L, Wettergreen SA, Marcus A, Schilling LM, Rothman MS, et al. A qualitative evaluation of a fracture liaison service in an academic healthcare system. American Journal of Health-System Pharmacy. 2026:zxag262. https://doi.org/10.1093/ajhp/zxag262
- 2.Hiyama Y. Impact of a national reimbursement policy for secondary fracture prevention on early secondary fractures after hip fracture surgery in Japan: a nationwide interrupted time series analysis. Archives of Osteoporosis. 2026;21(1):116. https://doi.org/10.1007/s11657-026-01759-w
- 3.Rodin R, Smith AK, Gan S, Espejo E, Boscardin J, Hunt LJ, et al. Days at Home After Hip Fracture Among Older Adults With and Without Dementia. JAMA Network Open. 2026;9(6):e2618658. https://doi.org/10.1001/jamanetworkopen.2026.18658
- 4.Haaber RS, Langdahl B, Nelissen R, Jensen SS, Andersen K, Pedersen AB. Mental disorders and osteoporosis treatment in patients with hip fracture—a Danish population-based cohort study. Osteoporosis International. 2026;37(7):1821-1831. https://doi.org/10.1007/s00198-026-07975-x
- 5.Abad MO, Ebert M, Jin J, Padubidri A, Khan LZ. The overlooked burden of nonattendance in hip fracture liaison models of care. JBMR Plus. 2025;10(1):ziaf185. https://doi.org/10.1093/jbmrpl/ziaf185
- 6.Tang N, Jiang L, Lei M, Su Q, Song J, Kong D, et al. Exploring the dilemma of secondary fracture prevention in Chinese families from the experience of elderly fragility fractures: a qualitative study based on Confucian cultural background. BMC Geriatrics. 2025;25(1):559. https://doi.org/10.1186/s12877-025-06236-6
- 7.Bennett MJ, Center JR, Carter S, Moles R, Perry L. Implementing pharmacist-led home medicines reviews within fracture liaison services for better post-fracture care: a qualitative study of patient and practitioner experience. Osteoporosis International. 2025;36(10):1883-1906. https://doi.org/10.1007/s00198-025-07589-9
- 8.Zheng HW, Bui AAT, Ensrud KE, Wright NC, Manson JE, Watts NB, et al. Identifying Younger Postmenopausal Women With Osteoporosis Using USPSTF-Recommended Osteoporosis Risk Assessment Tools. JAMA Network Open. 2025;8(3):e250626. https://doi.org/10.1001/jamanetworkopen.2025.0626
- 9.Andreasen C, Dahl C, Frihagen F, Borgen TT, Basso T, Gjertsen JE, et al. Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative). Osteoporosis International. 2025;36(3):501-512. https://doi.org/10.1007/s00198-024-07376-y
- 10.Ye C, Morin SN, Lix LM, McCloskey EV, Johansson H, Harvey NC, et al. Age at First Fracture and Later Fracture Risk in Older Adults Undergoing Osteoporosis Assessment. JAMA Network Open. 2024;7(12):e2448208. https://doi.org/10.1001/jamanetworkopen.2024.48208
- 11.Reppas-Rindlisbacher C, Boblitz A, Podolsky S, Fowler RA, Lapointe-Shaw L, Sheehan KA, et al. Language Preference, Surgical Wait Time, and Outcomes Among Older Adults With Hip Fracture. JAMA Network Open. 2024;7(11):e2448010. https://doi.org/10.1001/jamanetworkopen.2024.48010
- 12.Danazumi MS, Lightbody N, Dermody G. Effectiveness of fracture liaison service in reducing the risk of secondary fragility fractures in adults aged 50 and older: a systematic review and meta-analysis. Osteoporosis International. 2024;35(7):1133-1151. https://doi.org/10.1007/s00198-024-07052-1
- 13.Xu L, Zhao T, Perry L, Frost S, Di Tanna G, Wang S, et al. Return on investment of fracture liaison services: a systematic review and analysis. Osteoporosis International. 2024;35(6):951-969. https://doi.org/10.1007/s00198-024-07027-2
- 14.Benitez TM, Ouyang Z, Khouri AN, Fahmy JN, Wang L, Chung KC. Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture. JAMA Network Open. 2023;6(12):e2349621. https://doi.org/10.1001/jamanetworkopen.2023.49621
- 15.Dastmanesh S, Karimi M, Ghahremani L, Seif M, Zare E. A health communication campaign for prevention of osteoporosis in rural elderly women. BMC Women’s Health. 2023;23(1):124. https://doi.org/10.1186/s12905-023-02282-7
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Prior fracture as a predictor of later fracture | [10] | 2024 | Executive opening | Single Canadian province registry of people referred for bone density testing; observational associations. |
| Days at home and long-term care after hip fracture with and without dementia | [3] | 2026 | Continuum of care | U.S. Medicare claims for community-dwelling adults aged 65 and older; cannot separate disease severity from care pathway effects. |
| Performance of risk tools in younger postmenopausal women | [8] | 2025 | Current evidence | Women enrolled in a 1990s research cohort at three centers; may not reflect current populations. |
| Effectiveness of fracture liaison services on subsequent fracture and mortality | [12] [9] | 2025, 2024 | Current evidence | One-year pooled estimate rated low certainty; Norwegian stepped-wedge design across three hospital clusters may not generalize to U.S. systems. |
| Return on investment of fracture liaison services | [13] | 2024 | Access | Based on modeled cost-effectiveness studies with varied methods, settings and currencies. |
| Treatment initiation after hip fracture by mental health status | [4] | 2026 | Access | Danish registry data; differences in health system and prescribing may limit transfer. |
| Payment incentives for secondary fracture prevention | [2] | 2026 | Access | Single-country interrupted time series with a six-month outcome window; residual secular trends possible. |
| Nonattendance and post-discharge follow-up | [5] | 2025 | Continuum of care | Single-institution experience reported within a narrative review. |
| Racial, ethnic and language disparities in fracture care | [14] [11] | 2024, 2023 | Equity and trust | Observational administrative data from three U.S. states and one Canadian province; unmeasured confounding possible. |
| Workforce and implementation factors in liaison services | [7] [1] | 2026, 2025 | Human infrastructure | Qualitative interviews at a small number of sites; perspectives may not represent all settings. |
| Health communication and patient and family beliefs | [15] [6] | 2025, 2023 | Public communication | Small rural Iranian trial and a single-hospital qualitative study in Beijing; cultural context shapes transferability. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.