Background Low trauma forearm fractures may be the clues to a patient having osteoporosis. The gold standard for diagnosis is by dual energy x-ray absorptiometry (DXA) scan. Yet it is only in recent years that a fracture liaison service (FLS) has become a reality. Low trauma forearm fractures remain a huge economic burden to the health economy. The introduction of the Quality outcomes Framework (QOF) in 2013 recognised and rewarded health professionals in primary care for recording, diagnosing, and treating patients with osteoporosis.
Objectives To assess the cost savings obtained from a fracture liaison service set up with “zero cost”
Methods The FLS within the rheumatology department at the university hospitals of Leicester (UHL), records details of patients with low trauma forearm fractures. The data is obtained from the fracture clinic and passed to our department. In accordance with QOF, a DXA request form is completed on behalf of patients and they are informed of the proposed intervention. It is sent to GPs for their signature. Upon receipt of the signed DXA form, arrangement is made for the scan, and the result is sent back to GPs to act on the results accordingly.
Results 217 cases were recorded since the FLS was established. Those patients aged 75 or more, were advised to receive treatment without need for DXA scanning. These patients represented 40% (87) of the total cohort. Those aged ≥45 years were scanned upon receipt of the signed DXA request form from primary care.
130 patients between the ages of 45 and 74 were invited to have DXA scans performed following their forearm fracture. 82% (107) of the invited patients had DXA scans done. 36% (38) had T- scores in the osteoporotic range. A total of 125 patients were treated for osteoporosis.
Conclusions The “zero cost” is derived from the fact that the service is already available without further recruitment costs incurred by our department. Fracture nurse specialists under the employ of the orthopaedic department sends the relevant data on all forearm fracture patients to us for processing.
Correspondence with the GPs incurs little cost and effort. As a consequence of the QOF, primary care practices receive financial inducement, the UHL trust receives a fee from primary care for the scan, and the patient receives additional care coupled with fracture treatment.
From available data, the number need to treat (NNT) using alendronate to prevent one hip fracture is 92. Incorporating this into the data above (assuming 50% compliance) one can deduce that 7 hip fractures have been prevented. The cost of managing a patient with a hip fracture ranges from £3,000–£3,500. The cost however of treating a single patient with alendronate monthly for 5 years gives an overall cost of £240. One can derive from this a cost benefit ratio of 12.5, inferring that it would cost the NHS almost 13 times more money to treat a fractured hip compared to secondary treatment with alendronate.
With little funding, it should be possible to have an efficient FLS providing a more comprehensive case-finding strategies thereby preventing subsequent fractures and achieving potential cost savings.
Osteoporosis in the EU: Medical Management, Epidemiology and Economic Burden Arch Osteoporos 2013.
Wells GA et al. Alendronate for the primary and secondary prevention of osteoporotic fractures. Cochrane Database of Systematic Reviews 2008
Disclosure of Interest None declared