B.DING1, F. JOHARI1, R. RAMASON1, I.T.H. CHUA1, E.B.K KWEK1, R. KUNNASEGARAN1
Tan Tock Seng Hospital1
Patients with fragility fractures are frequently underdiagnosed, undertreated and go on to develop recurrent osteoporotic fractures after the sentinel event. This study evaluates the efficacy of an orthopaedic-surgeon-champion-driven Osteoporosis-Patient-Targeted-and-Integrated-Management-for-Active-Living (OPTIMAL) secondary fracture prevention program for reducing early fracture recurrence and improving treatment compliance against a Case-Manager-run Program (CMP).
This was a single-centre, cohort study of prospectively collected data of patients screened and treated for secondary osteoporotic fracture prevention from April 1, 2008, to June 30, 2018 at an orthopaedic unit. Patients recruited after January 1, 2014 were managed with an Orthopaedic Surgeon-Champion-designed-and-driven-Care-Model (OSC-CM) and compared against patients managed by a CMP from 2008 to 2013. Logistics regression analysis was used to identify significant predictors for patient recruitment, treatment compliance and secondary fracture rates at 12 months.
2855 out of 7388 patients screened for fragility fractures were suitable and agreed for recruitment into the OPTIMAL program. Hip fractures were the most common fragility fracture (3694, 49.9%). Implementation of the OSC-CM was associated with greater initiation of osteoporosis medication, OR 1.26 (95%CI 1.06–1.49, P=0.007). Of the 2855 patients recruited, OSC-CM implementation, OR 2.61 (95%CI 2.03–3.36, P<0.001) and a higher education level, OR 1.428 (95%CI 1.02–1.43, P=0.037) was associated with improved compliance to medication. OSC-CM implementation was the only factor associated with reduced risk of secondary fractures, OR 0.14 (95%CI 0.03–0.66, P=0.013).
A comprehensive secondary fracture prevention care model that is driven by an orthopaedic department and tailored to the unit’s specific needs improves treatment compliance and reduces early fracture recurrent rates.