Sat., 10/20/07 Geriatrics/Injury Prevention, Paper #47, 9:06 am OTA-2007
The Fracture and Osteoporosis Outpatient Clinic: Successful Intervention to Prevent Fractures after Fractures
Svenhjalmar van Helden, MD1 (a-MSD, Rocher-GSK, Nycomed);
Piet P Geusens, MD, PhD2,3 (a-MSD, Rocher-GSK, Nycomed); Rene ten Broeke, MD4 (n);
Peter R. G. Brink, MD, PhD1 (n);
1University Hospital Maastricht, Department of General Surgery/Traumatology, Maastricht, The Netherlands;
2University Hospital Maastricht, Department of Internal Medicine, Maastricht, The Netherlands;
3Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium;
4University Hospital Maastricht, Department of Orthopaedic Surgery, Maastricht, The Netherlands
Purpose: Patients with a history of clinical fracture are at increased risk for developing a new fracture, already within short term. Guidelines on osteoporosis and fall prevention advocate evaluation of such patients in order to prevent new fractures. The primary end point was the effect on fracture risk of systematic implementation of guidelines for osteoporosis and fall prevention in patients with a recent clinical fracture
Methods: During 1 year, a dedicated fracture nurse offered a bone-and-fall-related risk factor evaluation and treatment program according to the guidelines in The Netherlands to all patients older than age 50 years with a recent clinical fracture (n = 940, 670 women and 270 men). One-year fracture incidence was compared to the 6.5% 1-year incidence in all traceable 2,373 patients who were followed in 1999-2001 in the same hospital before the guidelines were available. Cox regression with adjustments for age, sex, and location of fractures was used to calculate the hazard ratio (HR, with 95% confidence interval [CI]) of the program compared to historical controls.
Results: After exclusion of patients with pathologic fractures (n = 14) and from abroad (n = 22), 33 out of 904 patients (3.7%) in the study group had a new clinical fracture within 1 year, indicating a risk reduction of 43% compared to controls (HR: 0.57; CI: 0.39-0.83).
16 out of the 568 patients (2.8%) who agreed to participate in the evaluation and treatment program had a new clinical fracture within 1 year, indicating a risk reduction of 54% compared to controls (HR: 0.46; CI: 0.28-0.77).
Conclusions and Significance: A significant reduction in new clinical fractures within 1 year in a fracture patient population can be achieved with the implementation of an intervention aimed at osteoporosis assessment combined with attention for fall risk factors. Implementation of such an intervention in all fracture care departments is therefore highly recommended.If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.