Improving osteoporosis management following minimal trauma fracture in a regional setting: The Coffs Fracture Card Project

Abstract

Objectives: To improve osteoporosis (OSP) management following minimal trauma fracture (MTF) with few additional resources. Design: Population intervention with serial cross-sectional analysis. Setting: Regional setting involving primary care, base hospital and private hospital. Participants: Patients with MTF. Intervention: A 'Fracture Card' prompting OSP management was provided to all patients post-MTF. Patients were encouraged to attend their general practitioner (GP) with this to discuss bone health issues. The 2-year intervention was supported by a public health education campaign. Main outcome measures: Number of (i) serum 25-OH vitamin D assays, (ii) dual-energy X-ray absorptiometry (DXA) scans, and (iii) new Pharmaceutical Benefits Scheme (PBS)-subsidised prescriptions for bone protective therapy (bisphosphonates, raloxifene, strontium, teriparatide, denosumab). Results: The number of serum 25-OH vitamin D assays ordered in Coffs Harbour increased from 329±15 per month (July 2009-June 2010) to 568±21 (July 2010-June 2012; P<0.001). The number of DXA scans performed per month increased from 192±14 (July 2009-June 2010) to 296±12 (July 2010-June 2012; P<0.001). There was no difference in the number of new PBS-subsidised prescriptions for bone protective therapy in the Coffs statistical subdivision over that time (176±3.8 per month, July 2009-June 2010 versus 180±3.5, July 2010-June 2012, P>0.05). Conclusions: The intervention was associated with an increased number of 25-OH vitamin D assays and DXA scans but not with more prescriptions for bone protective therapy. This suggests that a public health education campaign and provision of a 'prompt' for GPs was only partially successful at improving OSP management post-MTF. This has driven establishment of a Fracture Liaison Service. © 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.