Implementation of a clinical pathway for osteoporosis management within an Orthopaedic Fracture Clinic

Abstract

Background: A fracture liaison service (FLS) is a multidisciplinary system approach to reducing subsequent fracture risk in patients with a recent fragility fracture. This study investigated the utility of an alternate model delivered by orthopaedic surgeons in increasing the investigation and treatment of osteoporosis within an orthopaedic fracture clinic in a tertiary hospital. Method: We established a pathway of treatment (FLS) for women ≥50 years old with a minimal trauma fracture (MTF) in the orthopaedic fracture clinic using existing clinic resources to identify patients. All female patients ≥50 years old with upper limb MTFs during the study period were included and compared with historical controls prior to the intervention. The intervention and control groups were compared to assess the capacity of the new model of care to identify suitable patients and deliver best practice care. Results: After the intervention the cumulative rate of osteoporosis screening increased from 52/173 to 201/318 (P < 0.001). Among the patients who were screened for osteoporosis the treatment rate increased from 25/52 to 126/201 (P < 0.001). The intervention resulted in a significant reduction in patients who were not screened after MTF from 87/173 to 40/318 (P < 0.001). Conclusion:We have developed a low-cost pathway developed by the orthogeriatric team integrated into an orthopaedic fracture clinic that leads to increased screening and treatment of osteoporosis. This model was implemented in a tertiary hospital with an integrated inpatient orthogeriatric service and highly engaged orthopaedic surgeons and may not be applicable in other settings.