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VBCR - June 2014, Volume 3, No 3 - Osteoporosis
Rosemary Frei, MSc

Seville, Spain—A nurse-driven intervention appears to significantly improve osteoporosis care in older adults who present to the hospital after a fall, according to a preliminary study.

In the Australian study, a nurse assessed osteoporosis and fracture risk in 30 people who had fallen (Shibu PK, et al. Seville, Spain: World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Disorders; 2014. Poster 132).

The nurse liaised with the general physicians regarding further investigations and treatment for the patients, and also provided them with 1-on-1 counseling and other education. Patients’ rates of FRAX (Fracture Risk Assessment Tool) testing, vitamin D testing and use, and dual-energy x-ray absorpitometry (DEXA) scanning were much higher than among patients who had not received these interventions.

As a result, lead investigator Pazhvoor Shibu, MD, told Value-Based Care in Rheumatology, they have appointed a nurse to perform these functions with all patients presenting with fragility fractures to the orthopedic and medical areas.

“[Our] aim is to see if having a dedicated coordinator makes a significant difference in care,” said Dr Shibu, Consultant Geriatrician at the Queen Elizabeth Hospital, Woodville, South Australia, after the presentation of the results at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.

Dr Shibu and the other team members focused on people aged ≥65 years who were orthopedic and cardiology inpatients, and falls-clinic outpatients, who presented to the hospital after a fall. They compared 42 people who did not receive the 2-month intervention from the gerontology nurse to the 30 patients who did. The baseline demographics, comorbidities, and other characteristics were similar in both groups.

The educational component of the intervention was 1-on-1 counseling and advice on lifestyle and dietary modification to improve bone health. The nurse also gave the patients information about osteoporosis and provided them with easy-to-understand information leaflets and handouts to reinforce the information and education.

The FRAX testing rate was 5% in the group that did not receive the intervention and 100% in those who did. In addition, the rate of vitamin D testing increased from <50% to nearly 90%, and use of vitamin D increased from approximately 60% to 100%. Antiresorptive use improved as well, from approximately 40% to >70%, and DEXA scanning increased from 11.60% to 60% (all parameters, P<.01 for no intervention vs intervention).

“It was deemed necessary that the nurse ask patients whether they had an osteoporosis fragility fracture, and if they answered in the affirmative they would be treated as having osteo­porosis and DEXA was not required to start treatment,” Dr Shibu noted, as he explained why DEXA testing did not rise to 100%.

The osteoporosis diagnosis was conveyed to the general physician in 100% of the cases after the intervention, compared with just 62.8% in patients who did not receive the intervention.

In addition, the 2-month postintervention rates of adherence and persistence were very high for drug therapy and vitamin D use. Dairy intake and sun exposure also increased appreciably, according to Dr Shibu.

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