Results of a Model of Secondary Prevention for Osteoporotic Fracture Coordinated by Rheumatology and Focused on the Nurse and Primary Care Physicians

Abstract

ObjectiveTo assess the influence of the implementation of a program for secondary prevention of osteoporotic fractures on prescribing bisphosphonates and persistent short-term treatment. Patients and methodsPatients >50 years of age with fragility fracture attended in the emergency department were enrolled in an observational study. The program consisted of (1) training of primary care physicians, (2) baseline visit: questionnaire on osteoporosis, bone densitometry and patient education, (3) patient referral to primary care, except those with multiple fractures or requiring special study or therapy, who were referred to a specialist, and (4) follow-up by checking prescriptions in electronic records, and a telephone survey. The outcome variable was the percentage of patients who, on having been prescribed bisphosphonates, still adhered to the treatment at 3 months. ResultsOf the 532 patients with inclusion criteria, 202 (39%) refused to participate. Those who refused to take part had a higher mean age (P<.01) and a higher frequency of hip fracture (P<.01) compared with patients who did participate. A total of 330 patients were included for intervention, with a mean age of 71 years, and 254(77%) were women. An antiresorptive was being used by 45 patients (13%) at baseline. After the baseline visit 223 patients (67%) were recommended a bisphosphonate. In the follow-up at 3 months 78% of patients who had been prescribed bisphosphonate were still receiving treatment. ConclusionsWe present a multidisciplinary program for secondary prevention of fractures coordinated by rheumatology in which the number of patients who were receiving bisphosphonate at 3 months increased by four times compared to that at baseline visit.