Secondary Prevention of Fragility Fractures: Are We Following the Guidelines?

Abstract

The re-audit shows that, although there is an improvement in the situation, we are still below the standards of secondary prevention of fragility fractures with 60% of femoral fragility fracture patients not being referred for DEXA scan. A pathway lead by a fracture liaison nurse dedicated to osteoporotic fracture patients should improve the situation.

PRO-OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single-centre study

“…The results of this study demonstrate that an algorithmbased approach to secondary osteoporosis prophylaxis is a successful strategy, especially when it is combined with [21,22,[24][25][26]. The success of the results can be attributed to the uptake of most of the recommendations from previous studies and involvement of permanent staff (not rotation based) who are dedicated to osteoporosis management.…”

“…The follow-up audit permitted a direct comparison between three time periods, demonstrating any changes induced by the introduction of the multifaceted intervention. This method has been utilised in several studies examining osteoporosis guideline adherence including one reported on by Prasad et al [21]. The questionnaire administered to healthcare staff was designed to obtain feedback on workload requirements after the intervention introduction so that any workload-related problems could be identified and reconciled in post-intervention review period.…”

Coordinator-based systems for secondary prevention in fragility fracture patients

“…letters sent to primary care physicians with patient BMD results and treatment recommendations [22]) and some were much less intensive initiatives (e.g. audits of practices following release of new clinical practice guidelines [23,24]). Some studies depended on the patient as the agent of change and sent all education to the primary care provider through the patient [25].…”

“…In those with low bone mass, treatment was recommended [45]. Two studies conducted audits of OP care based on clinical practice guidelines [23,24], and one evaluated the effect of increased OP drug funding post-fracture [46]. It should be noted that some of these programmes may have also had a coordinator or dedicated staffing to mail letters or schedule BMD testing, for example.…”

Describing variation in the delivery of secondary fracture prevention after hip fracture: an overview of 11 hospitals within one regional area in England

“…Studies have shown that there is major variation in the care pathway for the treatment and management of hip fracture patients and in the way secondary fracture prevention services are organised [23][24][25][26][27][28][29][30]. In the context of England, fewer than 40 % of hospitals had established a FLS as of 2010 [31].…”