Issue 44 / 21 November 2011

THE health system is failing people with osteoporotic fractures, according to endocrinologists who are calling for the introduction of more fracture liaison services in Australian hospitals.

In an editorial in the latest issue of the MJA, Professor Markus Seibel, an endocrinologist at Concord Hospital in Sydney, said that 75%–80% of people with osteoporotic fractures were not investigated or treated for their underlying osteoporosis. (1)

“Nobody seems to ask why that person had a low-trauma fracture (or a second or third one) to begin with”, he wrote, describing the gaps in management as a “systematic failure”.

Professor Seibel told MJA InSight that there was a misconception that fractures and stooped posture were a normal part of ageing.

“Well, they’re not. We call it osteoporosis”, said Professor Seibel, who is also professor of endocrinology at the University of Sydney.

Concord Hospital is one of the few sites in Australia to run a fracture liaison service, which actively identifies patients with minimal-trauma fractures, investigates them for underlying osteoporosis, and manages this condition long-term.

In a recently published research paper, Professor Seibel and colleagues found that the Concord fracture liaison service reduced the risk of refracture by 80% over 4 years compared with standard care, while an economic analysis showed that it was also cost-effective. (2)

In fact, it was predicted to be cost-saving as more drugs became available in generic forms.

Professor Seibel called for the introduction of a fracture liaison service in every hospital in Australia.

“Its proven clinical and cost-effectiveness leave no excuses for not attempting to close the appalling gap in the post-fracture care of patients at high risk of fracture”, he wrote.

Professor Peter Ebeling, head of endocrinology at Western Health in Melbourne, agreed that low-trauma fractures were undermanaged, with neither GPs nor orthopaedic surgeons taking “ownership” to manage the underlying osteoporosis.

“Treatment that can reduce the risk of further fractures by about 50%-70% doesn’t get started; the system itself is broken and needs fixing”, he said.

Professor Ebeling said Osteoporosis Australia sought federal government funding for fracture liaison services 2 years ago, but was unsuccessful.

“Governments, both state and federal, need to realise that the fracture liaison service is one model that can work to reduce fractures and, with time, it can also become cost-effective. They need to address the problem with adequate resources, and they need to do it now.”

A spokesperson for the Agency for Clinical Innovation (ACI), a NSW Health statutory body, agreed that fracture liaison services were a “must have” and were cost-effective. The ACI is evaluating three pilot sites for additional fracture liaison services in NSW.

“This will build the case for systematic implementation of these services across NSW”, the spokesperson said.

Internationally, fracture liaison services have been shown to be clinically effective in the US, UK and Europe.

The US is facing similar issues to Australia in terms of managing people with low-trauma fractures. A statement released last week by the US National Bone Health Alliance said that most people aged over 50 years with an osteoporotic fracture were not treated to prevent further fractures. (3)

A key feature of the Alliance’s plan to reduce osteoporotic fractures by 20% by 2020 included the establishment of fracture liaison services within the US Medicare system and other health systems modelled on existing successful programs.

– Sophie McNamara

1. MJA 2011; 195: 566-567
2. Osteoporos Int 2011; 28 September (online)
3. National Bone Health Alliance: press release

Posted 21 November 2011

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