Inauguration of the Fracture Clinic
Written by Antonio Moroni
Wednesday, 26 July 2006
The osteoporotic fracture campaign recently took on the national challenge of setting up a fracture clinic with a 360-degree multidisciplinary approach — the first of its kind in Italy. In Italy nearly four million women are at risk, as well as an additional eight hundred thousand men. Because the primary objective of orthopaedic surgeons is treatment of fractures, they do not wish to assume central responsibility for the evaluation and management of the underlying chronic disease; however, identification of these patients through primary care practices has been unreliable and incomplete. Instead, the development of a fracture liaison service can assume the responsibility for assessing and performing diagnostic evaluations and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. In this setting, if treatment were indicated but either DXA scanning were not required or bisphosphonates were not going to be appropriate, recommendations would be made to the primary care physician to commence calcium and vitamin D administration without further assessment. At the time of bone density measurement, risk factors for osteoporosis and fractures are identified and discussed with the patient. Educational literature about osteoporosis and the reduction of fracture risk is given to the patient, and the risks and benefits of possible treatments, including appropriate lifestyle modifications (including participation in exercise classes i.e. Tai Chi) are agreed upon. This report is then sent to the general practitioner after the DXA clinic visit. A computerized database is necessary for the management of osteoporosis including fracture history, past medical history, risk factors for osteoporosis, risk factors for fracture, current medication use, DXA results and interpretation, lifestyle recommendations, osteoporosis treatment recommendations and arrangements for follow-up. The primary goal of this new center is to educate patients and increase awareness. Let us raise patient compliance, clinical patient monitoring and multidisciplinary network development!
Dual energy x-ray absorptiometry (DXA) scanners are used to diagnose high-risk patients for appropriate treatment allocation. Furthermore, the clinic houses a database registry for monitoring patient fracture risks, surgical treatment and pharmacological therapy in relation to osteoporosis. The aim of the center is also to involve medical specialists, scientists and researchers in order to establish joint ventures between companies and university centers on burning issues concerning osteoporosis.
Clearly, it is understood that when patients are diagnosed they seek treatment. This program promotes education, diagnosis and treatment in this enormous Italian patient population that remains at risk. Without diagnosis there can be no treatment.
Improving medicine management
The International Society for Fracture Repair, a charitable organization, alongside other industrial partners, is striving to encourage the local planning and provision of a range of additional or reconfigured services delivered by healthcare practitioners and by specialists in the care of people with these conditions. These initiatives are aimed at further improving older patients’ access to their medication and include updated collection and delivery services. Older people often need multidisciplinary assessment, which has not been available. The coordinated improvement action will ensure that no patient of whatever age spends more time than necessary in the hospital ward because of an osteoporotic fracture. The development of services both in hospital and the community for these conditions is providing one-on-one assistance so that patients can fully understand their condition and subsequent treatment modality. Therefore, a top priority for reducing pressure on emergency services is the development of improved management of long-term conditions in the community. Furthermore, older people would benefit greatly from increased hospital capacity for elective surgery, particularly in relation to orthopaedics, where intervention makes a big difference to their independence and quality of life.
Last Updated ( Wednesday, 26 July 2006 )