Care Fragmentation Leaves Most Fracture Patients Untreated for Osteoporosis

TLDR: Care fragmentation shows its measurable harm at the handoffs between medical specialties, and life sciences companies, organised along the same specialty lines, are positioned to help close those gaps.

Care fragmentation lives in the space between specialties

Care fragmentation describes a patient’s care spread across many providers who work in parallel. Researchers measure it from claims data, with indices that track how widely a person’s visits are dispersed across doctors. In a 2024 study of 4,296 Medicare beneficiaries, close to half had highly fragmented care, and that group had 61% higher adjusted odds of reporting an adverse event they attributed to poor coordination.

Fragmentation also carries a price. Among 506,376 commercially insured patients with chronic conditions, those in the most fragmented quartile of care cost an average of $10,396 a year against $5,854 in the least fragmented quartile, and had more preventable hospitalisations, 9.1% against 7.1%.

Each specialty can do its own job well while the person still loses ground. The surgeon fixes the wrist, the intensivist saves the life, the psychiatrist stabilises the mood, and each episode closes as a success in its own department. The loss becomes visible only when someone follows the same person across departments.

In 1977 the psychiatrist George Engel argued in Science for a biopsychosocial model of medicine, treating the person as one system of biological, psychological and social parts. Almost fifty years later his argument carries numbers, and they point to the same place every time: the handoff from one specialty to the next.

Four specialty handoffs with a measured gap in outcomes

From the fracture clinic to bone health. A fragility fracture is a strong signal of osteoporosis, and a costly one to miss. The International Osteoporosis Foundation (IOF) reports that only about one fifth of eligible fracture patients receive osteoporosis treatment after the fracture. A 2023 meta-analysis of 64 cohorts and more than 2.1 million people found that a previous fracture raises the risk of any new clinical fracture by a factor of 1.88. Orthopaedics treats the break, the bone disease belongs to another department, and the patient walks out between the two.

From intensive care to the mind. A 2019 meta-analysis in Critical Care pooled 48 studies and 7,152 adult survivors of critical illness and found post-traumatic stress symptoms in 19.8% of them, roughly one in five. Prevalence rose with time, reaching 20.2% beyond twelve months after discharge. The intensive care unit (ICU) measures survival; the psychological after-effects surface months later, in another setting, far from the team that treated the admission.

From psychiatry to the body. People with mental disorders lose an average of 14.66 years of potential life, according to a 2023 systematic review and meta-analysis in eClinicalMedicine covering 109 studies. Suicide and other unnatural causes account for the larger share, and natural causes, the cardiovascular, metabolic and respiratory diseases that physical medicine treats every day, account for 4.38 of those lost years. That share sits in the gap between the mental health service and the general practitioner or cardiologist, and it widens when mental health waiting lists delay the first contact with care.

From risk scores to the heart attack itself. Prevention runs on four standard modifiable risk factors: hypertension, diabetes, high cholesterol and smoking. In Sweden’s national registry, 14.9% of 62,048 patients with an ST-elevation myocardial infarction (STEMI) had none of those four factors, and that group had higher 30-day mortality than patients with them. A global meta-analysis of 1,285,722 patients with acute coronary syndrome confirmed the higher mortality. These patients sit outside the four factors the screening model looks for.

Switzerland built its system in pieces

Responsibilities in Swiss healthcare are split across the Confederation, 26 cantons and more than 2,000 municipalities, and a 2021 review in the International Journal of Integrated Care notes that each canton can be considered a slightly different health system. The same review counted 155 integrated care initiatives in a 2015–2016 national survey, half of them launched between 2010 and 2016, and rated the country low on funding, governance and standardisation for integration. Coordination exists in Switzerland as a collection of projects, while the default pathway still runs specialty by specialty.

The federal response starts with the data layer. DigiSanté, a ten-year programme for 2025 to 2034 with a credit of close to CHF 400 million, is led by the Federal Office of Public Health with the Federal Statistical Office and aims at secure, continuous data exchange between the actors of the health system. Kainjoo supports the Federal Office of Public Health on its rollout. Interoperable records show where the handoff breaks; acting on what they show falls to clinicians and to the companies that make and market treatments.

Life sciences companies are organised like the hospitals they serve

Large pharmaceutical companies organise their portfolios by therapeutic area; Novartis, for example, names four core therapeutic areas. Each of the four gaps above crosses one of those lines. The osteoporosis team speaks to rheumatologists and endocrinologists, while the fracture patient sits in orthopaedic trauma. The psychiatry team tracks adherence to treatment, while the patient’s lost years come from cardiometabolic disease. A cardiovascular team built around lipid and blood pressure targets reaches the patients who carry those risk factors. The value sits where those plans meet.

For medical affairs, the work starts with a patient journey mapped across therapeutic areas from the handoff outward. The highest-stakes moments in this evidence are transitions: discharge from intensive care, the first fracture visit, the first psychiatric admission. A patient journey owned at medical or country level, across therapeutic areas, captures those moments and gives each brand team a shared map of where its patients enter and leave care.

Market access and health economics teams have a tested model to fund. The IOF describes the fracture liaison service as a coordinated model of care in which every patient aged 50 and over presenting with a fragility fracture is assessed for fracture risk and treated according to national guidelines. A 2018 meta-analysis of 74 controlled studies found that these services raised treatment initiation by 20 percentage points and lowered refracture by 5 points against usual care. The same coordinator logic applies after intensive care and between mental health and primary care, and it gives payers a service they can evaluate against outcomes.

Real-world evidence teams can measure what happens after the handoff. Outcome measures that follow the person, such as treatment started within months of a fracture or a cardiometabolic check after a psychiatric admission, show whether the pathway worked. They also generate the cross-specialty data that single-specialty registries leave out.

Digital and brand teams gain most by tying each tool to a named handoff. A model trained inside one department and reporting to one department adds another layer of fragmentation. The same model connected to the next step in care, with a named owner for the result, becomes the link the pathway was missing. The test for any digital health investment is which handoff it closes and who acts on what it finds.

Engel described the body as one system in 1977. The evidence now puts a number on each place where care breaks that system into parts. A practical first step for any life sciences team is to pick one of the four handoffs above, name an owner for it across therapeutic areas, and measure the outcome one year after the transition.

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