The fracture and osteoporosis clinic: 1-year results and 3-month compliance

Introduction: A Fracture and Osteoporosis (F&O) clinic started in two major general hospitals in the South of the Netherlands on April 1st 2004. Its objectives were to perform easy and complete assessment of female and male patients aged 50 years and over, initially treated for a low-energy trauma fracture, and to evaluate its effectiveness for early diagnosis and treatment of osteoporosis. Methods: All eligible patients were selected from the digital X-ray system of the Emergency Department. DXA-scans and, if indicated, spinal radiographs were made. If osteoporosis was diagnosed, the F&O nurse explained the treatment strategy. Treatment advice was sent to the general practitioner (GP), who prescribed medication and provided further support. After 3 months, all osteoporosis patients received a compliance and side effects follow-up questionnaire. Results: Up to June 1st 2005, 1058 patients followed the diagnostic procedure; 584 patients did not. Three times more women (804) than men (254) suffered a fracture. Osteoporosis occurred 10% more often in women. Overall, 37.1% had osteoporosis, based on DXA-scan only, and 39.6% when spinal radiographs were added. Spinal radiographs of the thoracic and or lumbar spine were made in 166 patients, radiographs of the thorax in 114 patients. Overall, fractures of the wrist were most common, with fractures of the hand occurring most frequently in men (20.0%). All fracture sites, except foot and clavicula, were associated with a higher frequency of osteoporosis than in the Dutch population. The response rate to the 3-month compliance questionnaire was 73% increasing to 96% after telephone contact. 86% visited their GP; 11% did not because they already received anti-osteoporotic medication prior to the fracture. Bisphosphonates were prescribed to 84% and discontinued by 7%. 13% reported side effects of bisphosphonates. Only half of the patients received the recommended calcium supplementation. Conclusions: The F&O clinic with its digital X-ray system facilitated easy, complete identification of fracture patients and early treatment of osteoporosis, which was frequently diagnosed. Self-reported compliance was high. (c) 2007 Elsevier Inc. All rights reserved.