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Prevention of osteoporotic refractures in regional Australia
Author(s) -
Davidson Emily,
Seal Alexa,
Doyle Zelda,
Fielding Kerin,
McGirr Joe
Publication year - 2017
Publication title -
australian journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.48
H-Index - 49
eISSN - 1440-1584
pISSN - 1038-5282
DOI - 10.1111/ajr.12355
Subject(s) - medicine , cohort , osteoporosis , referral , bisphosphonate , cohort study , prospective cohort study , physical therapy , hazard ratio , rate ratio , bone mineral , emergency medicine , surgery , confidence interval , family medicine
Objective Clinical guidelines recommend that patients who sustain a minimal trauma fracture ( MTF ) should receive a bone mineral density ( BMD ) scan and bisphosphonate (or equivalent) therapy if diagnosed with osteoporosis. A pilot fracture liaison service ( FLS ) was implemented in regional NSW to improve adherence to the guidelines. Design Prospective cohort study with an historical control. Setting Primary care. Participants Control ( n = 47) and cohort ( n = 93) groups comprised patients consenting to interview who presented with a MTF to the major referral hospital 4 months before and 12 months after FLS implementation respectively. Main outcome measures Primary outcome measures were the rates of BMD scans and anti‐osteoporotic medication initiation/review after MTF . Hospital admission data were also examined to determine death and refracture rates for all patients presenting during the study period with a primary diagnosis of MTF within 3 years of their initial fracture. Results Although there was no improvement in BMD scanning rates, the reported rate of medication initiation/review after fracture was significantly higher ( P < 0.05) in the FLS cohort. However, once adjusted for age, this association was not significant ( P = 0.086). There was a lower refracture rate during the cohort period ( P = 0.013), however, there were significantly more deaths ( P = 0.035) within 3 years of initial fracture. When deaths were taken into account via competing risk regression, patients in the cohort period were significantly less likely to refracture than those in the control period (Hazard ratio = 0.576, P = 0.032). Conclusions A rurally based nurse‐led FLS was associated with modest improvement after MTF . Consideration should be given to ways to strengthen the model of care to improve outcomes.