QJM. 2019 Oct 31. pii: hcz271. doi: 10.1093/qjmed/hcz271. [Epub ahead of print]
Osteoporosis is common, increasing as the population ages and has significant consequences including fracture. Effective treatments are available.
To support proactive fracture risk assessment and optimizing treatment for high risk patients in primary care.
November 2017 to November 2018, support was provided to 71 practices comprising 69 of 90 practices within two NHS CCG areas. Total population 579,508 (207,263 aged over 50).
Fracture risk assessment (NICE CG146) in: males aged 75 and over females aged 65 and over females aged under 65 and males aged under 75 with risk factors under 50 with major risk factors.
158,946 met NICE CG146, 11,961 were coded with an osteoporosis diagnosis (7.5%), of those, 42% were prescribed treatment with a bone sparing agent (BSA). 6942 were assessed to initiate BSA. 30% of untreated osteoporosis diagnosis patients had never been prescribed BSA.Even when prescribed, 1700 people (35%) were for less than minimum recommended duration. 9,784 within the FRAX recommended to treat threshold, 3,197 (33%) were currently treated with BSA and 3,684 (37%) had no history of ever receiving BSA. From untreated patients, expected incidence of 875 fractures over a 3year period (approximately £3.4million). Treatment would prevent 274 fractures (cost reduction: £1,274,045, with prescribing costs: saving £805,145 after 3 years of treatment).
Under diagnosis and sub-optimal treatment of osteoporosis was identified. Results suggest that implementing NICE guidance and optimising treatment options could in practise is possible and could prevent significant fractures.