Osteoporosis is a common disease of the elderly. Many patients at high risk are neither identified nor treated. A Fracture Liaison Service is a coordinated model of care for secondary fracture prevention. Several national quality indicators have been published in each country to improve surgical treatment and osteoporosis medical treatment. Fracture Liaison Services in both countries have been created by local clinicians with different models depending on the medical geographic locations of patients and the local setup. The objective of this review is to describe the national guidelines and the current clinical treatment models for fragility fractures in South Africa and Israel. Successes and barriers to successful implementation have been identified and are summarized.
South Africa and Israel have significantly different health systems. As South Africa is geographically 500 times as large and has a population nearly 7 times as large as the state of Israel, major differences in the challenges and subsequent handling of the pandemic between these countries were to be expected. South Africa's challenges included being under-resourced, particularly related to trauma, and severe and radical measures had to be undertaken that included extended strict lockdowns, bans on alcohol sales, and cancellation of the majority of the elective surgery during this initial period of the pandemic. Although Israel is much smaller and thereby theoretically easier to control, a complex political situation created difficulties and delays in controlling the pandemic after the initial response, leading to a second wave and additional lockdown. Although massively engaged initially, the Israeli trauma systems had continued functioning almost normally throughout the COVID-19 crisis.
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