Endocrine Abstracts

Background: Osteoporosis leads to significant morbidity and disability through an increased susceptibility to fracture. Post-menopausal females are a high-risk group. A fracture liaison service model has been proposed as a method to maximise initiation of treatment for secondary prevention following a fragility fracture.

Aim: To compare practice in two fracture units to guidelines contained in the National Institute for Clinical Excellence (NICE) Technology Appraisal 87. One unit uses an orthogeriatrician (site A) and the other a fracture liaison service model (site B).

Methods: A sample group of 62 patients treated for a fracture at site A was compared with a sample group of 100 patients treated at site B. Female patients over 75 years of age with a diagnosis of fragility fracture were included.

Results: Seventy five percent (site A) and 62% (site B) of patients had sustained a fracture of neck of femur, 16% (site A) and 35% (site B) a wrist fracture and 9% (site A) and 3% (site B) a vertebral fracture. At site A 0% and at site B 1% underwent a DEXA scan. Treatment was consistent with the NICE guidelines in 53% (site A) and 78% (site B) of patients. (Difference 25%, P<0.001). Documentation of enquiry into risk factors was recorded in 5% (site A) and 66% (site B) of cases. Treatment was commenced for patients from site B by GPs in 97% of cases, whereas for site A GPs accounted for 12%, and the orthogeriatrician for 61%.

Conclusions: We compared practice in inpatient cohorts. In the unit with a fracture liaison service adherence to NICE guidelines and documentation of enquiry into risk factors is higher. Treatment is initiated by different professionals at both sites. A fracture liaison service results in 25% greater treatment rates and may show further benefits in the management of non-hospitalised fracture patients.