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Fracture prevention: a population based intervention delivered in primary care

Hoggard K1Hart S2Birchall J1Kirk S3Goff I4Grove M4Newton J2,5.

QJM. 2019 Oct 31. pii: hcz271. doi: 10.1093/qjmed/hcz271. [Epub ahead of print]

 

 

Abstract

BACKGROUND:

Osteoporosis is common, increasing as the population ages and has significant consequences including fracture. Effective treatments are available.

AIM:

To support proactive fracture risk assessment and optimizing treatment for high risk patients in primary care.

DESIGN:

Clinical cohort.

SETTING:

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).

PARTICIPANTS:

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.

RESULTS:

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).

CONCLUSION:

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.