Journal of Integrated Care Pathways > Volume 11, Number 3 > Pp. 126-127

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Conference reports

Use of an integrated care pathway in improving secondary prevention of osteoporosis

Gavin Dabrera

Foundation Year 2 Doctor
Luton and Dunstable NHS Foundation Trust
Luton LU4 0DZ, UK
Email: gavdab{at}yahoo.com

National Osteoporosis Society 12th Conference on Osteoporosis

25–28 November 2007, Edinburgh, Scotland

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Poster: Preventing the next hip fracture

J Gallagher, C Russell, S McNally, L Jeavons, J Stanton, J Smith

Eastbourne District General Hospital, Eastbourne, UK

	Summary

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The authors audited how many patients admitted with hip fractures were correctly commenced with treatment for the secondary prevention of osteoporosis by the time of discharge. Such treatments were recognized as the standard of care by current guidelines.

The initial audit cycle consisted of a retrospective review of 20 case notes of patients admitted with hip fractures, aged 65 years. This initial cycle identified that correct osteoporosis medications were started in only 40% of patients at discharge.

Following this, an integrated care pathway (ICP) combining different elements of care for patients admitted with hip fractures was introduced. This ICP included tick-boxes for expected actions, including prescription for medications for secondary treatment of osteoporosis.

A second cycle of audit was performed after the introduction of this ICP for 20 sets of case notes. This cycle found that prescription of medications for the secondary prevention of osteoporosis had increased to 80% by the time of discharge.

The authors concluded that the tick-box approach had acted as ‘an aide-memoir’ to improve the quality of patient care.

	Discussion

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Osteoporosis is a reduction in bone density that in turn can increase the risk of fractures. It increases in prevalence with age. Fractures are a concern as they are associated with reduced quality of life¹ and increased risk of depression.² Even after one fracture has occurred, it is important to begin treatment to reduce the risk of further fractures (secondary prevention).

Current National Institute for Health and Clinical Excellence (NICE) guidance states that postmenopausal women with confirmed osteoporotic fragility fractures should be started on bisphosphonates as a secondary prevention measure.³ This needs to be supplemented with calcium and vitamin D if intake of these are insufficient.

This audit focused on the implementation of this guidance in patients with hip fractures, who should be considered for this treatment. This can have a potentially significant impact on mortality and morbidity. For instance, the Horizon trial examined the use of a zoledronic acid infusion (a bisphosphonate) within 90 days of repair of fractured neck of femur. It found a decrease in all-cause mortality in patients receiving the drug.⁴ Although this specific bisphosphonate is not included in the NICE guidance, it illustrates the importance of prompt recognition and secondary prevention of osteoporosis in patients.

The ICP designed by the authors has been effective in improving the prescription of bisphosphonates as a secondary prevention measure for osteoporosis.

	References

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1. Salaffi F, Cimmino MA, Malavolta N, et al.; Italian Multicentre Osteoporotic Fracture Study Group. The burden of prevalent fractures on health-related quality of life in postmenopausal women with osteoporosis: the IMOF study. J Rheumatol 2007;34:1551–60 (Epub 15 May 2007)[Medline]
2. Silverman SL, Shen W, Minshall ME, Xie S, Moses KH. Prevalence of depressive symptoms in postmenopausal women with low bone mineral density and/or prevalent vertebral fracture: results from the Multiple Outcomes of Raloxifene Evaluation (MORE) study. J Rheumatol 2007;34:140–4[Medline]
3. National Institute for Health and Clinical Excellence. The Clinical Effectiveness and Cost Effectiveness of Technologies for the Secondary Prevention of Osteoporotic Fractures in Postmenopausal Women. See http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11550 (accessed 4 December 2007)
4. Lyles KW, Colón-Emeric CS, Magaziner JS, et al.; HORIZON Recurrent Fracture Trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007;357:1799–809 (Epub 17 September 2007)[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dabrera, G. Search for Related Content Social Bookmarking                      What's this?