Authors (including presenting author) :
Lui DTW(1), Lam JKY(1), Lee ACH(1), Loong CHN(1), Fong CHY(1), Kong LL(2), Cheung WY(3), Woo YC(1)
Affiliation :
(1)Department of Medicine, Queen Mary Hospital, (2)Quality & Safety Department, Queen Mary Hospital, (3)Department of Orthopaedics and Traumatology, Queen Mary Hospital
Introduction :
The increased morbidities and mortality in osteoporosis can be improved with anti-osteoporotic agents. However, a recent study revealed only 9-15% of hip fracture patients were treated within one-year post-event in the locality. A relay model for prescribing anti-osteoporotic agents was adopted in the osteoporotic vertebral fracture (OVF) pathway aiming to close the service gap.
Objectives :
We aim to review the performance of the relay model on patients’ anti-osteoporosis agent prescription from orthopaedic ward discharge to their first endocrinologist-led osteoporosis assessment (Endo).
Methodology :
A retrospective study of patients recruited into OVF pathway between 1 July 2015 and 30 June 2016. Malignant pathologies underlying vertebral fracture, eGFR < 30mL/min, patients followed up in regional or private clinics were excluded from this analysis. Prescription history of anti-osteoporotic agents upon discharge from orthopaedic ward, orthopaedic clinic, and by Endo was recorded. Deaths before Endo were censored.
Result & Outcome :
Among 176 entries, 161 patients were included for analysis. Median age was 85 years (IQR: 80.5-90.0). 137 were female and 24 were male. 136 (84.5%) were prescribed anti-osteoporotic agents upon discharge from orthopaedic ward. There were 28 deaths, 12 before the first orthopaedic clinic and 16 before Endo. 119 of 139 attending the first orthopaedics clinic (85.6%) continued to receive anti-osteoporotic agents. 101 of 133 (75.9%) attended Endo, 82 attendees (81.2%) were still on anti-osteoporotic agents. For the 19 attendees not taking anti-osteoporotic agents, 8 did not have medication initiated, 4 had medication discontinued due to intolerance or adverse events, and 3 had inadequate medication supply. Median time from OVF pathway entry to Endo was 93.5 weeks (IQR: 63.1–118.4). The prescription of anti-osteoporotic agents was successfully relayed in 61.7% (82 of 133) of patients. Older patients (86.3 vs 83.5 years, p=0.014) and men (p=0.006) were more likely to drop baton in this relay model. OVF pathway has significantly improved the rate of anti-osteoporotic treatment in patients with high fracture risk. Implementation of measures, particularly to older patients, is needed to further improve the success rate of passing the baton of anti-osteoporosis agent prescription from orthopaedic surgeons to endocrinologists.
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