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AB0607 Coordination of postfracture osteoporosis care by rheumatologist and nurse; preliminary results
  1. A. Naranjo1,
  2. S. Ojeda Bruno1,
  3. S. Rodríguez Moreno2,
  4. B. V. Díaz González3,
  5. A. Bilbao Cantarero1,
  6. J. C. Quevedo Abeledo1,
  7. C. Rodríguez-Lozano1
  1. 1Rheumatology
  2. 2Gerontology, Hospital Univ. Gran Canaria Dr. Negrin
  3. 3Primary Care, Gerencia de Atencion Primaria de Gran Canaria, Las Palmas de Gran Canaria, Spain

Abstract

Background Althoughmanagement of osteoporosis (OP) is cost-effective in high-risk patients, less than 20% of patients with fragility fracture receive antiresorptive drugs.

Objectives The main objective was to evaluate a program for secondary prevention of OP fracturesbased in the coordination between physicians and rheumatology nurse

Methods Patients >50 years with fragility fracture were enrolled in a prospective observational study. The program consisted of: 1) training of primary care physicians, 2) recruitment of patients from emergency unit registration, 3) baseline visit: questionnaire by the nurse (including FRAX variables) and bone densitometry (DXA); 4) patient education by the nurse about healthy habits, diet and prevention of falls; 5) clinical report, including recommendations about treatment, and referral to primary care of all patients, except those with multiple fractures or requiring special therapy, which were derived to the rheumatology service. A treatment algorithm based on the NOF 2010 guidelines was agreed between rheumatologists and primary care; and 6) follow-up through a phone survey and checking the prescriptions in electronic records. Asa reference group, we performed an analysis of treatments initiated in patients with fracture before the study. The outcome variables were: 1) the percentage of patients who initiated antiresorptive treatment at 3 months, and 2) percentage of patients who continued treatment at 1-3years.

Results The results of the first 8 months of the program are shown. In the retrospective analysis, a total of 23 (13%) out of 167 patients were prescribed antiresorptive drugs after a fracture. In the prospective study, 397 patients with inclusion criteria were contacted and invited to participate of which 156 (39%) did not agree to participate. Compared with those who agreed to participate, the patiens who refused were older (73 vs 70 years, P <0.01) and had a higher prevalence of hip fracture (27% vs 21%, p <0.01).

We included 249 patients for intervention (77% females). The location of the fracture was: forearm (n = 89), femur (n = 52), humerus (n = 45), vertebra (n = 15) and other bones (n = 48). 49 patients (19%) were using bisphosphonate at baseline visit. The DXA was normal in 46 cases (18%) and showed osteopenia in 97 (39%) and OP in 106 (42%). The average FRAX for major fracture was 12±10, with a risk for hip fracture >3% in 45% of cases. After the baseline visit 156 patients were referred to primary care (62%) and 92 patients to rheumatology clinic (37%). In total, antiresorptive treatment was recommended to 172 patients (69%), 167 a bisphosphonate and 5 denosumab. In the follow-up at 3 months, 73% of patients who had been prescribed antiresorptive were receiving treatment.

Conclusions We present the firstmultidisciplinary and multi-professional program for secondary prevention of fractures in Spain. The absolute number of patients who were prescribed antiresorptive increased by three times compared to standard management.

Acknowledgements Grant: Proyecto nacional del Ministerio de Ciencia e Innovación. Instituto de Salud Carlos III: PI11/01429

Disclosure of Interest None Declared

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