Improving osteoporosis management following minimal trauma fracture in a regional setting: The Coffs Fracture Card Project

Authors

  • Cheryl Tulk RN, DMU,

    1. Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
    Search for more papers by this author
  • Pam Lane Dip Phys,

    1. Physiotherapy Department, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
    Search for more papers by this author
  • Anne Gilbey RN,

    1. Department of Orthopaedics, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
    Search for more papers by this author
    • Formerly Department of Orthopaedics, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia (now deceased).
  • Helena Johnston MBBS, FRACMA FACRRM,

    1. Mid-North Coast Division of General Practice, Coffs Harbour, New South Wales, Australia
    Search for more papers by this author
  • Karen Chia MBBS, FAFRM (RACP),

    1. Ramsay Healthcare, Baringa Private Hospital, Coffs Harbour, New South Wales, Australia
    2. UNSW Rural Clinical School, Coffs Harbour, New South Wales, Australia
    Search for more papers by this author
  • Lee Mitchell RN,

    1. Ramsay Healthcare, Baringa Private Hospital, Coffs Harbour, New South Wales, Australia
    Search for more papers by this author
  • Hanish Bagga B. Med, Grad Dip Clin Epi, FRACP, CCPU,

    1. Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
    Search for more papers by this author
  • Peter K.K. Wong PhD, Grad Dip Clin Epi, FRACP, CCPU

    Corresponding author
    1. Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
    2. UNSW Rural Clinical School, Coffs Harbour, New South Wales, Australia
    • Correspondence: Associate Professor Peter Wong, Mid-North Coast Arthritis Clinic, PO Box 6307, Coffs Harbour, New South Wales, 2450, Australia. Email: peter.wong@westnet.com.au

    Search for more papers by this author

Abstract

Objectives

To improve osteoporosis (OSP) management following minimal trauma fracture (MTF) with few additional resources.

Design

Population intervention with serial cross-sectional analysis.

Setting

Regional setting involving primary care, base hospital and private hospital.

Participants

Patients with MTF.

Intervention

A ‘Fracture Card’ prompting OSP management was provided to all patients post-MTF. Patients were encouraged to attend their general practitioner (GP) with this to discuss bone health issues. The 2-year intervention was supported by a public health education campaign.

Main outcome measures

Number of (i) serum 25-OH vitamin D assays, (ii) dual-energy X-ray absorptiometry (DXA) scans, and (iii) new Pharmaceutical Benefits Scheme (PBS)-subsidised prescriptions for bone protective therapy (bisphosphonates, raloxifene, strontium, teriparatide, denosumab).

Results

The number of serum 25-OH vitamin D assays ordered in Coffs Harbour increased from 329 ± 15 per month (July 2009–June 2010) to 568 ± 21 (July 2010–June 2012; P< 0.001). The number of DXA scans performed per month increased from 192 ± 14 (July 2009–June 2010) to 296 ± 12 (July 2010–June 2012; P< 0.001). There was no difference in the number of new PBS-subsidised prescriptions for bone protective therapy in the Coffs statistical subdivision over that time (176 ± 3.8 per month, July 2009–June 2010 versus 180 ± 3.5, July 2010–June 2012, P> 0.05).

Conclusions

The intervention was associated with an increased number of 25-OH vitamin D assays and DXA scans but not with more prescriptions for bone protective therapy. This suggests that a public health education campaign and provision of a ‘prompt’ for GPs was only partially successful at improving OSP management post-MTF. This has driven establishment of a Fracture Liaison Service.

Ancillary