Lillias Nairn¹, Angela Bowman⁴, Adrian Piotrowski¹, Sue Davies⁴, Ewan Driver², Christian Girgis³, Roderick Clifton-Bligh³, Lyn March⁴

¹Physiotherapy, ²Neurosurgery, ³Endocrinology, ⁴Rheumatology Departments Royal North Shore Hospital (RNSH), St Leonards, NSW 2065

AIM

To review osteoporosis treatment and re-fracture rates among people identified by the RNSH Leading Better Value Care (LBVC) ORP service over the first 4 years between July 2016 and June 2020.

METHOD

An Automated Electronic Screening (AES) Tool was used to identify patients >=50 years with fracture attending RNSH. Eligible patients were also referred directly to ORP by GPs. Triage was performed by the Fracture Liaison Coordinator (FLC) (LN) and patients meeting criteria were referred for medical review (CG, RCB, LM). All data was collected in a purpose-built e-form in eMR with Klik sense data output and review of eMR to validate; re-fracture rate was determined by re-identification in the AES.

RESULTS

From 11,991 encounters 10, 058 patients were identified over the 4 years. 1326 represented due to a new fracture with crude re-fracture frequency of 13.2%. A total of 2483 patients were invited to the ORP service. Antiresorptive medication was recommended for 74% of those who attended. Among 1048 patients did not attend the ORP Service 10.7% re-fractured during the 4 years compared with 6.6% among 1435 patients who did attend the ORP Service (p< 0.001), representing an unadjusted 38% relative reduction and 4.1% absolute reduction. 

CONCLUSION

Re-fracture frequency was significantly lower among those who attended ORP compared to those who did not. The high volume of patients with fractures identified by the AES Tool could not be managed by the single FLC and the existing medical FTEs. At RNSH where ~2,500 aged >= 50 years present with fractures each year a fully staffed ORP should prevent 100 re-fractures over 4 years.