A 4 i ( Identify , Investigate , Intervene , Involvement ) Fragility Liaison Service to bridge the secondary fracture prevention care gap for Osteoporosis Vertebral Fractures .

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Authors (including presenting author) :
Law SW(1)(2), Chan Ka Wai (2) Chau WW(3), Ko SY(1)
Affiliation :
(1) Department of Orthopaedics and Traumatology, Tai Po Hospital (2) Department of Orthopaedics and Traumatology, Prince of Wales Hospital (3) Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong
Introduction :
A wide care gap exists between the occurrence of vertebral fragility fractures and the diagnosis and treatment of osteoporosis. The underlying causes of fracture i.e. osteoporosis and sagittal mal-alignment remain under-diagnosed and under-treated resulting in imminent fracture within first year. This care gap in secondary prevention must be addressed to minimize both the debilitating consequences of subsequent fractures for patients and the associated burden to hospital because of readmission. The preferred model of secondary prevention is known as fracture liaison service ( FLS ) is now recommended by many health organization and societies .
Objectives :
In the retrospective phase, the clinical records of 200 patients with VCF were reviewed as historical cohort . In the planning phase, a “4i FLS “was designed which include 1 .identification of cases 2.i nvestigate and 3. intervene for underlying osteoporosis with the objective of secondary fracture prevention and finally, the forth “i” involvement of patients and caregivers through education in nurse led clinics for drug compliance, fall prevention strategy.
Methodology :
All participants underwent prospective follow-up at baseline, one year and two years intervals. Descriptive analysis and comparisons between participants enrolled before and after the implementation of the Follow Ups at baseline, six and twelve month are presented.
Result & Outcome :
Before the implementation of the “4i “ FLS , we found that only 4% of them received diagnostic or therapeutic indications for the osteoporosis. 15 cases out of 200 ( 7.5% )get second fracture required admission within 1 year. In the implementing phase, First “i ” identification of patients ,262 patients were enrolled into “4i “care pathway between 1 December 2016 and 31 December 2018. , Second “i” -Investigation : all patients got Bone Mineral Density( BMD ) measurement , sagittal alignment evaluation. The mean T- score at Spine was -2.38±1.53 (N=247, T-Score < -2.5 =124) and at Hip was -1.89±1.20 (N=246, T-Score < -2.5 =77). All patients got sagittal mal-alignment required intervention. Third “i” Intervene, all patients received calcium/vitamin D and/or osteoporosis medication according to the result of BMD . The forth “i: involvement , all patients have education , consultation session through nurse led clinics On subsequent follow up ,only 3 out of 262 patients ( 1.1 %) got a second fracture on 2 years follow up. The implementation of a 4 i FLS with component of nurse led clinics has been proven to be effective for implementation of secondary prevention of fragility fractures .

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