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Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
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Role of Vitamins in Maintaining Bone Health

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Urinary Tract Calculi IV: Nutrition Therapy and Prevention

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Osteoclasts in Bone Remodeling

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Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles

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The SIMPLER Nutrition Pathway for Fragility Fractures: A Quality Improvement Initiative.

Jack J Bell^1,2, Olof Gudny Geirsdottir^1,2, Antony Johansen^2,3

¹Faculty of Food Science and Nutrition, School of Health at the University of Iceland, 102 Reykjavik, Iceland.

|June 27, 2025

Summary

Malnutrition worsens outcomes for older adults with fragility fractures. The SIMPLER Nutrition Pathway and toolkit were co-created and tested to improve evidence-based nutrition care globally for these patients.

Keywords:

fragility fracture hip fracture hospitals implementation improvement malnutrition nutritional support protocol quality improvement

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Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents

Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents

Published on: August 14, 2018

Area of Science:

Geriatric Medicine
Nutrition Science
Quality Improvement in Healthcare

Background:

Malnutrition significantly increases complications, functional decline, and mortality in older adults with fragility fractures.
Existing evidence supports early, interdisciplinary nutrition care, particularly for hip fractures, yet implementation remains suboptimal globally.
A gap exists between recommended nutrition interventions and their actual application in fragility fracture care.

Purpose of the Study:

To co-create and test a pathway and toolkit (SIMPLER) for delivering evidence-based nutrition care in global fragility fracture settings.
To address the identified evidence-practice gap in nutrition interventions for patients with fragility fractures.
To develop a scalable and adaptable framework for improving nutrition care in this vulnerable population.

Main Methods:

A multiphase, co-creation quality improvement initiative (2018-2025) guided by the Knowledge-to-Action framework.
Development and iterative refinement of the SIMPLER Pathway and toolkit through expert and clinical team engagement.
Pilot testing in five hospitals across four countries, utilizing action-reflection cycles and the Model for Improvement.

Main Results:

Over 100 co-creation activities involved staff and patients in refining the SIMPLER pathway.
Global surveys, audits, and interviews confirmed a widespread evidence-practice gap in nutrition care for fragility fractures.
Pilot testing led to context-tailored improvements, with 46 healthcare services in 23 countries committing to SIMPLER implementation.

Conclusions:

The SIMPLER Nutrition Pathway offers a scalable and adaptable framework for evidence-based nutrition care in fragility fracture settings.
The co-creation approach facilitated the development of a practical toolkit addressing real-world implementation challenges.
Global adoption is increasing, indicating the potential for widespread impact on patient outcomes.