Volume 196 - Issue 6
No more excuses: fracture liaison services work and are cost-effective
Authors: David Spencer, Graydon Howe and Nicholas Manolios
Med J Aust 2012; 196 (6): 384. || doi: 10.5694/mja12.10166
Published online: 2 April 2012
Published online: 2 April 2012
To the Editor: The editorial by Seibel1 was timely, given the promotion in February last year by the New South Wales Agency for Clinical Innovation of an osteoporotic refracture prevention model of care. The evidence presented by Seibel is compelling — osteoporosis is a serious, undermanaged and preventable problem, and there are no more excuses for not instituting refracture prevention protocols in major teaching hospitals. Not only do these programs work to prevent further patient morbidity and mortality, but they are cost-effective in reducing the burgeoning public hospital costs associated with recurrent fractures and hospital admissions. We question the delay in implementing such programs.
One cost analysis showed that treating 214 patients saved $156 713 and reduced hospital stays by 270 bed-days over a 2-year period (John Van der Kallen, Rheumatologist, Hunter New England Local Health District, personal communication). More than 10 years ago, we demonstrated that minimal trauma fractures were inadequately managed and preventable, and outlined a cost-effective clinical pathway for monitoring and treating these patients when they presented through the emergency department.2-5 Had this program been instituted by the medical administration at that time, there would have been a saving over a 10-year period of more than $2 million by one major Sydney teaching hospital alone. Despite much talk and “hype” on the part of medical and allied health professionals, medical administrators and government agencies, nothing has eventuated. Unless there is an injection of funds from health departments and a willingness from hospital administrators to implement such programs, we believe that “nothing” will be what continues to happen.
Competing interests
The Department of Rheumatology, Westmead Hospital, received a grant-in-aid from Aventis Pharma to complete the osteoporosis study.
References
- Seibel MJ. No more excuses: fracture liaison services work and are cost-effective [editorial]. Med J Aust 2011; 195: 566-567. seibel1234
- Phoon S, Spencer D, Manolios N, Howe G. Effectiveness of managing osteoporosis in the primary care setting [abstract]. Intern Med J 2003; 33: A1-A22. 0_CBBDGFCA
- Phoon S, Spencer D, Manolios N, Howe G. Prospective screening of osteoporosis in patients with minimal trauma fractures presenting to the Emergency Department: a six month review [abstract]. Intern Med J 2003; 33: A1-A22. 0_pgfId-2516154
- Wong PKK, Spencer DG, McElduff P, et al. Secondary screening for osteoporosis in patients admitted with a minimal-trauma fracture to a major teaching hospital. Intern Med J 2003; 33: 505-510. 0_CBBJHEIH
- Wong PKK, Spencer DG, Manolios N, et al. Osteoporotic fractures — do we care [abstract]? Intern Med J 2003; 33: A1-A22. 0_CBBEIDDA