Implementing an osteoporosis refracture prevention (ORP) service for South Western Sydney

Aim: To implement a patient centred re-fracture prevention service in Liverpool Hospital. This includes identification, assessment and treatment of all patients >50 years old presenting to Liverpool Hospital with a minimal trauma fracture. Method: Prior to the implementation, the Fracture Liaison Coordinator (FLC) conducted site visits across NSW and attended several FLC Network Meetings. By collaborating with the Emergency Department, we developed a system enabling a weekly report to be generated listing all patients aged >50 years who have sustained a fracture. We initially found the proportion of patients who had completed bone mineral density (BMD) testing prior to medical review was very low (20%). Various factors were identified including the culturally diverse population (25% of patients required interpreters) and long waiting times for booking radiology appointments in the public hospital. A public/private partnership was established with a local private rheumatology service to provide quick access to bone mineral density testing. The private BMD provider proactively contacted patients where necessary and offered an appointment within 1 week, including offering interpreter services. Results: To date, 246 patients have been seen by the FLC and rheumatologist. 88% of patients were prescribed pharmacotherapy to reduce fracture risk. Reasons for not starting treatment included medical contraindications and patient preference. The development of a public/private partnership with a local Liverpool Rheumatology clinic improved our BMD completion rates at the initial medical officer review appointment from 20% to 75%. Conclusions: The Liverpool Hospital ORP service has grown significantly over the last 12 months. We provide holistic patient-centred care with a multidisciplinary treating team. Initiating a private/public partnership significantly improved access to bone mineral density testing. Future work will focus on expanding the service to capture all minimal trauma fractures in South-West Sydney.