Age and Ageing 2015; 44: ii1–ii11 doi: 10.1093/ageing/afv106
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Clinical quality
37
A MULTIDISCIPLINARY APPROACH TO COMPLEX BONE HEALTH ISSUES IN ORTHOGERIATRIC PRACTICE
S. Bandyopadhyay, I. Wilkinson, S. Griffith, T. Giokarini-Royal, L. Ferrigan Bone Health Multi-Disciplinary Team, Surrey and Sussex Healthcare NHS Trust Topic: Osteoporosis is a common, debilitating condition affecting many frail elderly patients, leading to an estimated 180,000 fragility fractures per year in the UK. Correct treatment of fragility fractures has been shown to reduce the incidence of and mortality associated with further fractures. The introduction of newer treatments has made treatment rationale more complex. Intervention: We held a monthly multidisciplinary bone health meeting to discuss the management of patients with complex bone health problems. The MDT consisted of: orthogeriatric team, rheumatology and acute and community specialist nurses in osteoporosis. Initially all referrals were from the orthogeriatric unit. From March 2013 to October 2014, 113 patients were discussed. 104(92%) had sustained a
fractured neck of femur(NOF), 3 atypical femoral fractures and 4 vertebral fractures. 79% were female. 54% were previously undiagnosed and untreated. 63% were between 75-90yrs of age, 21% were 90yrs. 67% patients were Vitamin D deplete (2 years(43%), gastrointestinal complications(30%), renal disease(14%), compliance concerns(10%) and dental/jaw issues(4% patients). Improvement: The MDT discussion has led to initiation or change in treatment for all but 3 patients. In 58% the recommendation was to improve Vitamin D. The treatments recommended were: Denosumab(25%), intravenous Bisphosphonate(20%), oral Bisphosphonate (11.5%) and Teriparatide(5.3%). In comparison to the 20 month period immediately prior to the MDT was set up, more NOF patients were referred for DXA(8% vs 2.3%) and a follow up review (7% vs 0.66%). Discussion: The service utilises pre-existing community osteoporosis treatment networks which have been established over many years. MDT discussion has increased the treatment options available to orthogeriatric patients. The relationship with rheumatology has provided access to Zolendronic acid and Teriparatide. The link-up with rheumatology and the osteoporosis specialist nurses has allowed seamless community follow up for treatments such as Denosumab. The ability to continue some of these services is under threat from proposed health service reorganisation. We have increased the use of the injectable treatments which has implications for the delivery of that service. We believe the MDT can improve quality of care for our patients and encourage referrals from other disciplines. The input of a renal physician would further strengthen the service due to the prevalence of renal disease seen in the MDT.
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