Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.

PURPOSE Low-energy fractures experienced by women at midlife and beyond place them at increased risk of future fractures and may be early indicators of low bone density. We report here on women's postfracture narratives to provide insight into how family physicians might tailor their messages to patients in communicating risk.METHODS An interview guide was used in face-to-face interviews with women aged 40 years and older. Patients were asked to describe their fracture experience and recovery during the subsequent year. Interviews were audiorecorded and transcribed verbatim. Analysis was done initially using an immersion-crystallization approach.RESULTS Twenty-two women participated in this research. The analysis showed women's reactions to information about their risk fell into 3 groups. The fi rst took a laissez faire approach, preferring to wait and see what the future held. The second group recognized some of the things they should be doing but were inconsistent in maintaining changes or seeking relevant information. The third group saw information about future risk as salient and important to their daily lives. They actively sought out information, including discussions with their family physicians.CONCLUSIONS Discovering whether patients have had an injury and, if so, how they perceive future risk is important because the invisibility of this health hazard calls for vigilance early on in women's lives. Family physicians can help patients move from perceiving the fractures as isolated accidents to understanding them as indicators of future risk by discussing the importance of bone health in the short and long term. INTRODUCTIONU ntil recently the focus on bone health for women tended to be on osteoporosis, a condition of established chronic disease and a source of considerable public health cost. [1][2][3][4][5][6][7][8] In Canada, 1 in 4 women and 1 in 8 men aged 50 years and older have osteoporosis.9 The risk of low-energy fractures is substantial: at a population level women have a 1 in 6 lifetime risk of hip fractures, as compared with a 1 in 9 risk of developing breast cancer.2,10,11 Recent research in Canada projects an annual total cost for femoral fractures alone (about three quarters occurring in women) at $10 billion, rising to $20 billion if osteoporotic fractures are included.12 Aside from economic costs, the "quality of life impact of hip, wrist and vertebral fractures" is often overlooked.5 Earlier research by our team has shown that the short-and long-term sequelae of extremity fractures, including time off work, the need for support for activities of daily living, and permanent loss of function and disfi gurement, 13 are great, even in the absence of established disease.Prevention, early detection, and cost-effective treatment are possible and recommended to save pain, suffering, and health care costs of osteoporosis and related fractures. 14 Currently the role of family physicians in relation to fragility fracture prevention is hampered by 2 factors. First, there is inconsistent tr...

Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.

Objective: To gain understanding of the experiences and sequelae of fractures in women aged 40-65 years and to assess whether it is linked to overall bone health assessment. Method: A qualitative study using face-to-face indepth interviews. Findings: Contrary to the common belief that fractures are benign, for middle-aged women, fractures have a significant impact on their well-being in both the short and long term. Women report significant pain as well as an immediate need for help from family and professional caregivers. They experience interruptions to daily and leisure activities, employment, daily life and mobility. Only a minority of women and/or their family physicians initiated follow up to investigate bone health subsequent to the fracture. Conclusions: Bone health is often examined in the context of already established bone disease. This study suggests a need for a closer examination of fracture treatment in the context of preventive care, and early detection of osteoporosis. La traduction du résumé se trouve à la fin de l'article.