299 Impact of a dedicated fracture liaison service candidate ANP on wait times in a geriatrician-led specialist bone health service

Abstract

Abstract Background A specialist osteoporosis and bone health service was founded in 2003 in our institution. It sees a range of patients—providing DXA alone to giving specialist opinion on complex cases from all Ireland. Dedicated flow for hip fractures is well established however the advent of the fracture liaison database audit brought challenges providing DXA and reviewing specific acute fractures within the 12 week standard. Fracture liaison services target those who’ve just fractured with the aim of reducing risk of further imminent fracture by screening for osteoporosis and initiating bone protection measures. Methods Wait times for unselected direct review in the nurse led pre-assessment clinic with DXA were compared to the direct identification, review of DXA and subsequent follow up if indicated by a newly appointed candidate ANP (cANP). Results Average wait time for initial review of acute Colles/vertebral/humeral fractures prior to the cANP appointment was 10 months with further waits for consultant led bone clinic. Following the cANP appointment 318 relevant fractures were identified from September 2022 to May 2023. A 3 month lag was applied. Initial DXA took place on average 10 weeks post fracture (range 2–24). After this 169 patients were discharged back to GP with recommendations as scores above −2.0 on DXA as per locally agreed protocol for fractures and osteopenia; 111 seen in FLS by cANP for detailed assessment including bloods and risk factor review under supervision of their clinical mentor. 6 have not attended; the remainder await review. Average time from fracture to review by cANP is already 18 weeks. Conclusion Appointment of a dedicated cANP for fracture liaison has already streamlined bone health assessment for acute fractures attending our hospital as well as freed appointments in the specialist bone service. As the FLS service establishes we expect to reach the 12 week target consistently.