Understanding posttraumatic growth in palliative care: a qualitatively driven mixed-methods study using patients' life narratives.

Noncommunicable diseases and chronic conditions associated with population aging increase the demand for care and services and necessitate the economic sustainability of health care systems. One example of this complex scenario is fragility fractures, which occur worldwide at a frequency of 70 events per minute. Fragility fractures are defined as fractures resulting from low-energy trauma, typically a fall from standing height or less, and are strongly associated with underlying skeletal fragility. These fractures predominantly affect individuals aged ≥ 50 years and are more common in women, largely because of the higher incidence of low bone mineral density (BMD) and osteoporosis in this population. It is estimated that one in three women and one in five men over the age of 50 will experience an osteoporotic fracture during their lifetime. Osteoporosis, which affects approximately 500 million men and women worldwide, is characterized by reduced bone mass and deterioration of bonemicroarchitecture, resulting from an imbalance between bone resorption and bone formation. Its development is influenced by aging, hormonal changes, and several secondary causes, including chronic alcohol consumption, inflammatory rheumatic diseases, and endocrine, hepatic, or renal disorders. Fragility fractures most commonly involve the hip, vertebrae, distal radius, and proximal humerus. Although the association between osteoporosis and fragility fractures is well established in the scientific literature, substantial gaps persist in postfracture diagnosis, risk stratification, and the initiation of appropriate secondary prevention strategies. These fractures are accompanied by physical and psychological complications, such as pain, loss of mobility, and reduced quality of life, autonomy, and independence. Fear of falling, anxiety and depression are often reported. Finally, fractures are also associated with increased hospitalization morbidity and mortality. The annual cost of osteoporosis fractures to healthcare systems worldwide is $400 billion, accounting for approximately 3% of healthcare costs. In the European Union, these costs amount to 37.4 billion euros, representing approximately 3% of total healthcare costs. The International Osteoporosis Foundation implemented the “Capture the Fracture” program internationally to stimulate the detection of patients with osteoporotic fractures and avoid a second fracture. Treatment strategies include nonpharmacological approaches and osteoprotective measures. Several osteoporosis societies recognize fracture liaison services as the most efficient organizational model for enhancing assessment and treatment following osteoporotic fractures and as cost-effective for preventing secondary fractures. The imminent fracture risk, which is highest in the immediate postfracture interval, calls for prompt interventions to optimize the benefits of preventive and rehabilitation treatments. The use of behavior change interventions has increased in primary care. In this context, printed educational materials are advised to support brief interventions, even though no outcome improvement has been clearly demonstrated. Thus, simple behavioral patterns in everyday life can significantly impact health.