To the Editor: The Australian Fracture Prevention Summit held in 2002 recognised osteoporosis as a major public health issue. Despite this, several Australian studies have found that a majority of patients with osteoporosis-related fractures do not receive appropriate evaluation and treatment as recommended by the clinical guidelines.1-4

In 2003, the Queen Elizabeth Hospital, a tertiary referral hospital which services the north-western suburbs of metropolitan Adelaide, implemented a novel approach to improve the secondary prevention management of patients admitted to the orthopaedic unit with fragility fractures. The strategy was based on the “plan-do-study-action” principle of medical quality improvement, with the primary goal of enhancing performance.5

Before commencing, a retrospective case-note review of 40 consecutive patients who had been admitted to the orthopaedic unit with osteoporotic fractures revealed that, at discharge, none were receiving any medication for osteoporosis.

Patients over the age of 50 years who had been admitted with fragility fractures were identified from computer records. With the support of a physician and junior medical staff, a clinical pharmacist provided individual counselling, written materials and osteoporosis therapy. The rate of medication prescription was initially assessed at discharge. In a follow-up telephone interview, participants were queried about the continuation of osteoporosis therapy, performance of investigations by general practitioners, and history of falls.

Over a 10-month period, of 259 patients admitted with fragility fractures, 228 patients (88%) were prescribed osteoporosis therapy (calcium, vitamin D and risedronate) on discharge. Of those eligible, 65 patients participated in the follow-up audit. Forty-eight patients (74%) continued to take medications for osteoporosis as initially prescribed; only 28% had had laboratory investigations for osteoporosis and 31% a bone mineral density test. In addition, three patients had experienced recurrent falls complicated by further fragility fractures.

The appointment of an allied health champion with clinical backup from a general physician appeared to have achieved a high level of initiation and continuation of osteoporosis pharmacotherapy in at-risk patients during hospital admission. The low rate of follow-up investigations is consistent with previously published data suggesting poor community-based follow-up after hospital discharge of patients admitted for osteoporotic fractures.

The major limitation of this clinical pathway is the low rate of patient participation in the follow-up audit. Therefore, the results of follow-up data cannot be said to be representative of the cohort.

This study highlights the importance of the participation of GPs in maintaining patient compliance with hospital-initiated programs, especially those involving chronic illnesses.