All patients who present with a fracture at the Queen Elizabeth Hospital in Woolwich are referred to the fracture liaison service – one of the few services of its kind in the UK – where a specialist fracture prevention nurse initiates investigations for osteoporosis.
The nurses see more than 2,000 patients a year, including those at high risk of fracture such as COPD patients taking steroids or those on aromatase inhibitors for breast cancer.
In line with NICE guidelines on osteoporotic fractures, the nurse specialist conducts a risk assessment on all patients – including a falls risk – arranges bone density scans and offers lifestyle advice and education.
For patients found to have osteoporosis, the nurse can also recommend drug treatment – such as oral bisphosphonates – to prevent further fractures where necessary.
Although bisphosphonates are an effective treatment for osteoporosis, compliance can be low – with some studies reporting only a 50% adherence rate. But a two-year audit of the Queen Elizabeth Hospital service found that 81% of patients were still taking their oral bisphosphonates 18 months after treatment started.
This high compliance rate has largely been attributed to the work of the nurses at the fracture liaison service, who also make follow-up calls to all patients on daily bisphosphonates six to eight weeks after their appointment.
Patients also have access to a helpline at all times, and are provided with comprehensive support materials by the nurses.
Pam Vandenbosch, fracture prevention nurse specialist for the fracture liaison service, said: ‘Compliance with bisphosphonates can be low because they can cause gastric problems and aching bones.
‘Our patients know that if they cannot tolerate the medication for any reason, they can call us at any time and we will invite them back to discuss other options, such as taking the medication intravenously.’
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