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The fracture and osteoporosis outpatient clinic: an effective strategy for improving implementation of an osteoporosis guideline

Authors

  • Svenhjalmar Van Helden MD,

    Corresponding author
    1. Consultant, Department of General Surgery, Academic Hospital of Maastricht, Maastricht, the Netherlands
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  • Evelyne Cauberg MD,

    1. Medical student, Department of General Surgery, Academic Hospital of Maastricht, Maastricht, the Netherlands
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  • Piet Geusens MD PhD,

    1. Consultant, Department of Rheumatology, Academic Hospital of Maastricht, Maastricht, the Netherlands and Senior Investigator, University Hasselt, Hasselt, Belgium
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  • Bjorn Winkes PhD,

    1. Statistician, Department of Methodology and Statistics, Academic Hospital of Maastricht, Maastricht, the Netherlands
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  • Trudy Van Der Weijden MD PhD,

    1. Senior Investigator, Department of General Practice/Centre for Quality of Care Research, Academic Hospital of Maastricht, Maastricht, the Netherlands
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  • Peter Brink MD PhD

    1. Consultant, Department of General Surgery, Academic Hospital of Maastricht, Maastricht, the Netherlands
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Svenhjalmar van Helden
Department of General Surgery
Academic Hospital of Maastricht
Postbus 5800, 6202 AZ Maastricht
the Netherlands
E-mail: s.vanhelden@surgery.azm.nl

Abstract

Background  Clinical screening for osteoporosis in women aged over 50 years following a fracture is advocated by all guidelines on osteoporosis, but such attitude is widely reported to be inadequate. The aim of this study was to evaluate the effect of a strategy comparing referral for a dual-energy X-ray absorptiometry (DXA) scan as part of the osteoporosis guideline by a dedicated osteoporosis nurse with referral in hospitals without the presence of an osteoporosis nurse.

Methods  We retrospectively compared one reference hospital with five surrounding hospitals in the Netherlands. During a 2-week period, all female patients aged over 50 years who presented with a fracture at the emergency department of the six hospitals were included. Follow-up was minimal 11 weeks. The primary outcome was the referral for DXA measurement.

Results  In total, 135 patients were included, of whom 33 were seen in the reference hospital and 102 in the surrounding hospitals. In both groups, mean age and fracture location were similar. In the reference hospital, 14 patients qualified for DXA measurement, of whom 10 patients effectively underwent a DXA scan (71%). In the surrounding hospitals, 78 patients qualified for DXA measurement, of whom only three effectively underwent a DXA scan (4%). Taking into account a refusal percentage for DXA of 33% as was found in the reference centre, 47 patients in the surrounding hospitals should have been qualified for DXA measurement. Thus, successful referral in the surrounding hospitals was three out of 47 (6%) patients. The presence of an osteoporosis nurse did have a significant influence on the amount of DXA scans after fractures [RR 11 (95% CI: 3.6–35.1)].

Conclusions  This study indicates that referral for DXA is low in surrounding hospitals, and suggests that the presence of an osteoporosis nurse in the reference hospital significantly increased the number of patients receiving adequate osteoporosis screening with DXA measurement after a recent fracture. With this strategy patients who are at risk of osteoporosis are identified effectively, after which treatment can be started, in order to reduce the risk of future fractures.

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