1Physiotherapy, 2Neurosurgery, 3Endocrinology, 4Rheumatology Departments Royal North Shore Hospital (RNSH), St Leonards, NSW 2065
AIM
To review osteoporosis treatment and refracture rates among people attending the RNS 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 fractures. Triage was performed by the Fracture Liaison Coordinator (FLC) (LN) and eligible patients were invited to attend the ORP. 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 identified by re-identification in the AES post-ORP visit.
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 and 1435 attended. Antiresorptive medication was recommended for 75%. Among 1048 patients who did not attend ORP 10.7% (n=112) re-fractured compared with 5.6% (n=80) among 1435 patients who did attend the ORP Service (p<0.001) yielding an unadjusted 38% relative reduction and 4.1% absolute reduction. The 874 who attended and reported taking the recommended medication sustained 54 (5.6%) re-fractures in follow-up, while the 210 who did not take the recommended therapy had 16 re-fractures (7.5%) (p=0.2).
CONCLUSION: The triage process effectively identifies patients requiring anti-resorptive therapy. Re-fracture frequency was significantly lower among those who attended ORP compared with those who did not. There was a trend in benefit when patients adhered to recommended treatment. The high volume of patients with fracture identified by the AES Tool could not be managed by the single FLC and 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.