Background: Musculoskeletal conditions (MSK) including fragility fractures are at low priority in most health-care systems despite their enormous impact on societal costs. MSK are the leading cause of disability globally, accounting for up to 24% of YLD according to WHO. Falls are increasingly contributing. In advanced health-care systems, among women >70yrs, falls, accounts for 7.2% YLD. Fracture incidence is very high in Sweden, with high related disability and mortality. However, recognition by governmental policies has been low and slow.

Method: Major steps were taken in 2021 with national recommendations on osteoporosis from three governmental agencies – National Board Health Welfare, Medical Products Agency, and Swedish Association of Health-care Regions. Based on evidence, FLS gained the highest priority together with anti-osteoporosis medications (AOM). Standardized care pathways for secondary prevention were developed, highliting coordinators and including early AOM treatment. Implementation was directly mandated to the health-care regions.

Result: The first evaluation was conducted in 2023 showing limited implementation with fracture coordinators present in 14/21 regions(1). Overall, in about 70% of regions, written in-patients FLS routines were available; in-hospital AOM had increased (Zol/Dmab) from <10% 2019 to ~17% 2022 (DDD), whereas overall oral AOM remained ~12%(1).These results were the driving force for an orthopedic community initiative launched in 2023, to increase AOM treatment, firstly after hip fracture. Recently, this has led to establishing FFN Sweden 2025.

Conclusion: National policies provide an essential framework and guidance, but initiatives by those delivering care are equally important to achieve the goals.