Improving diagnosis and treatment of osteoporosis: evaluation of a clinical pathway for low trauma fractures

SUMMARY: Diagnosis and treatment of osteoporosis in hospitals is poor. We compared patient outcomes before and after implementation of a clinical protocol for low-trauma fractures. Patients in the pathway were more likely to receive information about osteoporosis or osteoporosis medications. Therefore our clinical pathway is effective in improving osteoporosis information and treatment. INTRODUCTION: Effective therapies for reducing fracture risk are available, yet under-utilised in hospital settings. We aimed to increase rates of initiation of osteoporosis investigations, pharmacological treatment, treatment continuation, and follow-up general practitioner (GP) visits. METHODS: Comparison of patient outcomes before and after implementation of a clinical pathway in patients admitted for low-trauma fractures to the Department of Orthopaedics and Trauma at The Queen Elizabeth Hospital, Adelaide. RESULTS: Patients enrolled in the osteoporosis clinical pathway (n = 28) were more likely than patients receiving usual care (n = 28) to have received information about (54% vs. 29%; p < 0.05), or a prescription for osteoporosis medication (53% vs. 25%, p < 0.05). Differences in proportions of patients visiting their GP post fracture and in osteoporosis investigations suggested or undertaken were not significant. At the later audit, the high proportion of patients receiving information about osteoporosis medication had been maintained (51%). Prescription of osteoporosis medications increased to 83% (p < 0.01), and more patients saw their GP post fracture (87%; p < 0.01). High rates of medication adherence were reported in patients in all groups receiving prescriptions. CONCLUSION: A clinical pathway for improving hospital management of osteoporosis is effective in improving education about, prescription for, and uptake of osteoporosis medications.