A fracture liaison service linked to a hospital ED information system has been shown to increase best practice care following minimal trauma fractures, reduce recurrent fractures and improve quality of life.
People at risk were identified after an ED visit and offered an appointment at the Fragile Bone Clinic along with investigations for osteoporosis, a medical management plan, allied health support and community services.
Outcomes from the service at Sir Charles Gairdner Hospital in WA were compared to those of a retrospective control cohort at the same hospital and a prospective control cohort at Fremantle Hospital.
The study found recurrent fracture rates at just three months follow-up were 1.5% in the intervention group, 6.7% in the prospective controls and 8.7% in the retrospective controls.
At 12 months, the rates were 8.1%, 17.3% and 18.3% respectively.
The reduction in recurrent fracture rates equated to preventing about 100 fractures for each 1,000 patient-years, the study said.
“Put another way the number need to treat to avoid a recurrent fractures was 9-10 patients to prevent 1 fracture.”
Patients in the intervention group were about twice as likely to receive osteoporosis-related investigations including blood and bone mineral density tests, more likely to have discussed osteoporosis with a doctor, and more likely to have changed or started osteoporosis medications than controls.
They also had about half the rate of falls at three months as the prospective control group (9.5 v 20%).
Prof Inderjeeth
Clinical Professor Charles Inderjeeth, a clinical epidemiologist and specialist in geriatric medicine and rheumatology, told the limbic the model of care used the ED database to identify patients at risk without interfering with the daily activities of the department.
A yet to be published analysis had also shown there was a significant return on investment in such a program by preventing ‘future fractures, future care, future hospitalisations and future transfers to residential care’.
“The most surprising finding for us was the absolute risk reduction and even the relative risk reduction was beyond the expectations we had – 50-75% as early as 3 months and persisting at 12 months.”
He said the improved outcomes were despite relatively small increases in the prescription of anti-resorptive therapies, and observed earlier than expected.
“What this demonstrated to us was not just the importance of pharmacological intervention but the multidisciplinary model of care.”
“In this older, frailer group with upper limb fractures, multidisciplinary team intervention includes medical assessment and modification of medical risk, modification of falls risk, modification of environmental risk – a composite of medical and allied health, carers and support services.”
“Improving the patient’s physical capacity probably made a big impact on reducing their fracture risk. It’s not about simply treating the bones with drugs, but also reducing the other factors that contribute.”
“So it certainly seems to be a very effective model in terms of providing better quality patient care but also in terms of savings to taxpayers and governments on a state and national basis.”