A secondary fracture prevention programme to reduce fractures, hospital admissions, and mortality rates at one and five years

Abstract

Introduction: Osteoporosis patients with a prior fracture have a much higher risk of re-fracture. Anti-osteoporosis medications reduce fractures only with prolonged treatment. In 2000, a Secondary Fracture Prevention Programme was piloted in Queen Mary Hospital to evaluate and treat patients with osteoporotic fractures. Objectives: (1) To triage and identify post-fracture patients with good survival and quality of life to minimize unnecessary osteoporosis drug treatment; (2) To reduce re-fractures, (3) To reduce mortality with osteoporosis drug treatment, and (4) To lower cost for hospitals to treat preventable re-fractures. Methodology: Patients with low-traumatic fractures underwent a structured evaluation and triage system for treatment and systematic follow-up programme. The triage was done by a registered nurse in-charged of the programme. Outcome measures included (1) refracture rate; (2) re-admission rate; and (3) mortality rate at 1-, and 5-years using survival analysis. Results: 2,364 fracture patients (1,606 female and 758 male) admitted to Queen Mary Hospital between April 2000 and April 2009 were screened. 1,078 (45.6%) had hip fractures, 565 (23.9%) spine fractures, 31 (13.2%) distal radius fractures and 410 (17.3%) fractures at other sites. 80.2% of patients fulfilled the inclusion criteria and were included into the program. About 80% of these patients were started on anti-osteoporotic medications. The re-fracture rate at 1 and 5 years of patients who received anti-osteoporosis medications were significantly lower than those did not receive medications (both p<0.05). Patients who satisfied the inclusion criteria but did not receive anti-osteoporosis medications had significantly higher re-admission and mortality rates at 1- and 5- years (all p<0.05). Patients who were excluded from the program have significantly lower re-fracture rate but higher mortality rates due to other causes at all time-points (all p<0.05). Anti-osteoporosis medications reduced risk of hip fractures by 88.8%, spine fractures by 88.3%, and other fractures by 82.8% at 12 months. The average cost of bisphosphonates, an effective anti-osteoporosis medication, is $1,400/patient-year. The Hospital Authority Statistical Report for 2007 recorded a total of 25,713 fractures. Based on these data, the secondary fracture prevention programme is estimated to provide a cost-saving of $100,260,300 per year. Conclusion: A structured triage and management programme for secondary fracture prevention was effective in identifying patients with better quality of life who are more likely to benefit from anti-osteoporosis medication, therefore reducing unnecessary drug prescription. Judicial use of anti-osteoporosis agents was effective in reducing re-fractures, and mortality and achieving cost-savings.