PRO‐OSTEO Extend I study (improving osteoporosis management in the acute and rehabilitation settings): multicentre audit

Abstract

Background Osteoporosis contributes to a large number of admissions to hospitals after minimal‐trauma fractures but is poorly recognised as an underlying cause of admissions and may be inadequately managed following hospitalisation. Aim The aim of this study was to examine osteoporosis management across Peninsula Health, assessing the effect of the introduction of a standard form to guide osteoporosis management after minimal‐trauma fractures. Method This was a retrospective cohort study measuring rates of osteoporosis assessment and treatment for patients admitted with minimal‐trauma fractures. Two periods were compared (in 2012 and 2013), before and after the introduction of an osteoporosis management form that allowed a pharmacist‐driven approach to management. The study end points were the extents of use of the osteoporosis form and the rates of osteoporosis assessment and treatment. Results Osteoporosis assessment and treatment rates varied widely across Peninsula Health, with acute wards such as the emergency departments providing no assessment or treatment (before and after the intervention). The uptake of the osteoporosis management form was negligible in the post‐intervention period. The overall 2‐year mortality rate was 7.4% following any fracture within 2 years of admission, and up to 33% following a hip or neck of femur fracture at some sites. Conclusion Osteoporosis management remained inadequate in the hospital settings despite intervention. Strategies such as ongoing prescriber education and employment of a local change champion specialised in osteoporosis management with support from all departments may be needed to achieve the aim of lowering the morbidity and mortality associated with this disease.

Prevalence of Medication-Related Risks for Falls and Osteoporosis at a Hospital Network: A Post-hoc Analysis

“…The PRO-OSTEO Extend 1 study has shown that the falls population treated at one of the Victorian Healthcare Services is similar to others [9] , and carries a significant medication-related burden in relation to medications that increase the risk of falls, with an average of more than 3 drugs per patient. This study has identified that PPI therapy was strongly associated with increased fracture rate, combined use with active osteoporosis treatment and a trend towards reduced treatment efficacy.…”

“…Over the two-year study period 560 patient admissions met the inclusion criteria and 305 admissions met the exclusion criteria for PRO-OSTEO Extend 1 study [9] . As part of this post-hoc analysis, 32 patients were excluded as the analysis examined adult population after minimal-trauma hospital admission.…”

“…The PRO-OSTEO Extend 1 study method is described elsewhere, but briefly, the study was a retrospective cohort study measuring rates of osteoporosis assessment and treatment for patients admitted with minimal-trauma fractures. The study was conducted over a 2 year period across one of south-east healthcare networks in Melbourne, as an extension of a pilot study that was carried out in 2010 [9,15] .The study sites included three rehabilitation facilities as well as two acute hospitals. The healthcare service consists of a dedicated age-care and orthopaedics ward, with an orthopaedics surgical, an aged-care and a combination of an ortho-geriatric review teams.…”

“…fracture population [9] . The aim of the primary study intervention was to improve the level of osteoporosis assessment and treatment among patients admitted to the healthcare service with minimaltrauma fractures utilising clinical pharmacists' contributions to a multidisciplinary approach.…”

Colecalciferol Initiation Post Minimal Trauma Fracture

“…Despite availability of evidence-based treatments, colecalciferol initiation rates of osteoporosis post minimal trauma fracture continue to be suboptimal. 11 This tertiary hospital audit site does not currently have a reliable process for the initiation of colecalciferol therapy post minimal trauma fracture, and anecdotal reports from clinical pharmacists suggest inconsistent practices for initiation between hospital units. Many patients are referred to their general practitioner for follow-up, and some patients receive no instructions.…”