Secondary fracture prevention needs to happen in the country too: The first two and a half years of the Coffs Fracture Prevention Clinic

Abstract

Objective: To report the initial two and a half years' experience of one of the first Fracture Liaison Services in regional Australia.

Design: Case study.

Setting: Hospital Clinic, mid-north coast NSW.

Participants: Patients aged ≥50 years with a fragility fracture identified at Coffs Harbour Health Campus July 2012 to December 2014.

Intervention: Patients were identified by a Fracture Liaison Coordinator (FLC) and seen in Fracture Prevention Clinic (FPC) by a rheumatologist. Patients discharged from FPC were contacted via telephone on one occasion 12 months later.

Main outcome measures: Number/characteristics of patients seen in or declining an appointment in FPC, type of bone protective therapy commenced and patient adherence with this.

Results: An appointment in FPC was offered to 222 patients but declined by 56 patients. One hundred and sixty-six patients were seen in FPC, of whom 40% (n = 66/166) had a prevalent fragility fracture but only 12% (n = 8/66) were on bone protective therapy. Eighty-two percent (n = 136/166) commenced bone protective therapy. Of the 55 patients discharged from FPC with long enough follow-up to allow contact at 12 months, 60% (n = 33/55) required bone health advice during the follow-up telephone call at 12 months. Of the 31 patients who commenced bone protective therapy, 65% (n = 20/31) said they were adherent with medication.

Conclusions: A FLC, committed clinician and supportive hospital environment were all that was required for an effective Fracture Liaison Service in a regional hospital. The number of patients who declined an appointment suggested the implications of a fragility fracture were often not appreciated.

Keywords: fracture coordinator; fracture liaison; fracture prevention; osteoporosis; regional.