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The impact of an osteoporosis clinical guideline on rates of referral to an osteoporosis clinic
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Abstracts / Bone 44 (2009) S68–S98
P. sarmentosum possessed a natural antioxidant, naringenin, belonging to the superoxide group. Our own previous studies have shown that P. sarmentosum has the ability to inhibit the 11-β-hydroxysteroid dehydrogenase (11-βHSD) enzyme, an enzyme important in the synthesis of cortisol. Based on this and also its antioxidant property, we hypothesize that P. sarmentosum will be able to prevent osteoporosis in a rat model of excess glucocorticoids. Forty male Sprague–Dawley rats, aged 3 months and weighing between 200 and 250 g were used. Twenty-four animals were adrenalectomized and replaced with intramuscular dexamethasone 120 μg/kg/day. They were simultaneously given either P. sarmentosum 0.125 g/kg/day, glycyrrhizic acid (GCA) 240 μg/kg/day or vehicle distilled water (adrx-control group) daily by oral gavage. A group of eight animals were sham-operated and given vehicle daily, i.e. intramuscular olive and oral distilled water. The treatment was given for 8 weeks. The group given GCA was used as a comparison since GCA had been proven to inhibit 11-βHSD enzyme, therefore reducing serum cortisol levels. A baseline control group was used to determine whether any significant stress was induced in the sham-control group. The results after eight weeks showed increased serum cortisol levels in the adrx-control group compared to the sham-control group. However, in the groups treated with P. sarmentosum and GCA, the serum cortisol levels were maintained at sham-control levels. Plasma pyridinoline (bone resorption marker) levels were lower in the P. sarmentosum and GCA groups compared to the adrx-control group. No difference in serum osteocalcin levels were detected between all the groups. In conclusion, the results showed that P. sarmentosum was as effective as GCA in preventing the increased cortisol levels seen in adrenalectomised rats treated with dexamethasone. This was associated with reduced bone resorption activity. Therefore, this suggests that P. sarmentosum is potentially useful in prevention of osteoporosis induced by long-term glucocorticoid therapy. doi:10.1016/j.bone.2009.01.177
262 The impact of an osteoporosis clinical guideline on rates of referral to an osteoporosis clinic C.A. Inderjeetha,b,c, D. Glennona, K. Polanda, K. Ingrama Area Rehab and Aged Care Osborne Park Hospital Program, North Metropolitan Health Service, Nedlands, WA, Australia University of Western Australia, Perth, Australia NHMRC NICS DVA Fellowship Program, Australia Purpose: Osteoporosis is under recognised and under treated in the tertiary setting. In response, Area Rehabilitation and Aged Care commenced a service to provide investigation and management services to post-minimal trauma fracture (MTF) patients. The clinic, named the Fragile Bone Clinic, was designed to review patients aged 65 and over who were discharged directly from the Emergency Department (ED). Despite establishment of the Fragile Bone Clinic, referral rates remained low, with 20 referrals received during 2006 and 2007 combined. Methods: A clinical guideline on investigation and management of patients post-MTF was developed by Area Rehabilitation and Aged Care staff, in consultation with clinicians interested in osteoporosis, and widely disseminated throughout the hospital in late 2007. Results: Between 1st January 2008 and 30th September 2008, 37,854 patients presented to the tertiary ED. Of these patients, 30% were aged 65 and over. In this age group 5% of patients were considered to have MTF.
Of the 569 MTF patients aged 65 and over, 194 (34%) were eligible for referral to the Fragile Bone Clinic. Of the patients eligible for referral to the clinic, 26% (51) were referred. When patients were offered review at the clinic 84% accepted an appointment. During the period 01/01/2008–30/09/2008:
Number
Percent
Patients reviewed in the Emergency Department Patients aged 65 years and over reviewed in the Emergency Department Patients aged 65 years and over with a MTF Patients eligible for referral to the Fragile Bone Clinic Patients referred to the Fragile Bone Clinic Patients reviewed in the Fragile Bone Clinic
37,854 11,436
30
569 194 51 43
5 34 26 84
Conclusion: Implementation of a clinical guideline for investigation and management of MTF patients resulted in an increased rate of referral to an Osteoporosis Clinic. This suggests that, among other strategies, the presence of a clinical guideline may increase rates of osteoporosis awareness and referral by clinicians. doi:10.1016/j.bone.2009.01.178
263 Osteoporosis survey: GP management post fragility fracture C.A. Inderjeetha,b, K. Polanda Area Rehab and Aged Care Osborne Park Hospital Program, North Metropolitan Health Service, Nedlands, WA, Australia NHMRC NICS DVA Fellowship Program, Australia Purpose: Patients with fragility fracture secondary to osteoporosis are at risk of recurrent fracture. Osteoporosis (OP) is often under recognised and under treated. A previous study (1), confirmed low rates of awareness, investigation and treatment following fragility fracture. We surveyed General Practitioners (GPs) to assess their attitude to osteoporosis investigation and treatment following a fracture. Methods: GPs were invited to complete a web based survey (Survey Monkey). The survey included questions on GPs attitude to review, informing, investigating, treatment, follow up, referral and responsibility for care of patients following a fragility fracture. Results: A total of 306 GPs have responded so far. Their approach to managing their patients following a fracture are summarised in the table below. There were concerns about short and long term side effects of bisphosphonates (22% and 32%), Strontium Ranelate (27% and 31%) and Raloxifene (20% and 29%). There was a significant association between GP review on discharge and Investigation and initiation of OP treatment (p < 0.05). There was a significant association between the initiation of specific OP treatment and concern re short term side effects of bisphosphonates and Strontium Ranelate (p < 0.05); but not the long term concerns.
GPs who always or mostly:
Percent
Review patients on discharge from hospital Inform patients they have OP Request a BMD to assess patients regularly Their responsibility to investigate patients for OP Commence calcium supplements Commence vitamin D supplements Commence specific OP treatment Consider “other doctor” responsible for OP Refer patient to “other doctor or clinic”
78 84 42 85 83 67 73 22 7
Conclusion: This survey suggests higher rates of review, investigation and treatment of patients by GPs following fragility fracture. This is at odds with published data on rates of patient awareness, investigation
Abstracts / Bone 44 (2009) S68–S98
P. sarmentosum possessed a natural antioxidant, naringenin, belonging to the superoxide group. Our own previous studies have shown that P. sarmentosum has the ability to inhibit the 11-β-hydroxysteroid dehydrogenase (11-βHSD) enzyme, an enzyme important in the synthesis of cortisol. Based on this and also its antioxidant property, we hypothesize that P. sarmentosum will be able to prevent osteoporosis in a rat model of excess glucocorticoids. Forty male Sprague–Dawley rats, aged 3 months and weighing between 200 and 250 g were used. Twenty-four animals were adrenalectomized and replaced with intramuscular dexamethasone 120 μg/kg/day. They were simultaneously given either P. sarmentosum 0.125 g/kg/day, glycyrrhizic acid (GCA) 240 μg/kg/day or vehicle distilled water (adrx-control group) daily by oral gavage. A group of eight animals were sham-operated and given vehicle daily, i.e. intramuscular olive and oral distilled water. The treatment was given for 8 weeks. The group given GCA was used as a comparison since GCA had been proven to inhibit 11-βHSD enzyme, therefore reducing serum cortisol levels. A baseline control group was used to determine whether any significant stress was induced in the sham-control group. The results after eight weeks showed increased serum cortisol levels in the adrx-control group compared to the sham-control group. However, in the groups treated with P. sarmentosum and GCA, the serum cortisol levels were maintained at sham-control levels. Plasma pyridinoline (bone resorption marker) levels were lower in the P. sarmentosum and GCA groups compared to the adrx-control group. No difference in serum osteocalcin levels were detected between all the groups. In conclusion, the results showed that P. sarmentosum was as effective as GCA in preventing the increased cortisol levels seen in adrenalectomised rats treated with dexamethasone. This was associated with reduced bone resorption activity. Therefore, this suggests that P. sarmentosum is potentially useful in prevention of osteoporosis induced by long-term glucocorticoid therapy. doi:10.1016/j.bone.2009.01.177
262 The impact of an osteoporosis clinical guideline on rates of referral to an osteoporosis clinic C.A. Inderjeetha,b,c, D. Glennona, K. Polanda, K. Ingrama Area Rehab and Aged Care Osborne Park Hospital Program, North Metropolitan Health Service, Nedlands, WA, Australia University of Western Australia, Perth, Australia NHMRC NICS DVA Fellowship Program, Australia Purpose: Osteoporosis is under recognised and under treated in the tertiary setting. In response, Area Rehabilitation and Aged Care commenced a service to provide investigation and management services to post-minimal trauma fracture (MTF) patients. The clinic, named the Fragile Bone Clinic, was designed to review patients aged 65 and over who were discharged directly from the Emergency Department (ED). Despite establishment of the Fragile Bone Clinic, referral rates remained low, with 20 referrals received during 2006 and 2007 combined. Methods: A clinical guideline on investigation and management of patients post-MTF was developed by Area Rehabilitation and Aged Care staff, in consultation with clinicians interested in osteoporosis, and widely disseminated throughout the hospital in late 2007. Results: Between 1st January 2008 and 30th September 2008, 37,854 patients presented to the tertiary ED. Of these patients, 30% were aged 65 and over. In this age group 5% of patients were considered to have MTF.
Of the 569 MTF patients aged 65 and over, 194 (34%) were eligible for referral to the Fragile Bone Clinic. Of the patients eligible for referral to the clinic, 26% (51) were referred. When patients were offered review at the clinic 84% accepted an appointment. During the period 01/01/2008–30/09/2008:
Number
Percent
Patients reviewed in the Emergency Department Patients aged 65 years and over reviewed in the Emergency Department Patients aged 65 years and over with a MTF Patients eligible for referral to the Fragile Bone Clinic Patients referred to the Fragile Bone Clinic Patients reviewed in the Fragile Bone Clinic
37,854 11,436
30
569 194 51 43
5 34 26 84
Conclusion: Implementation of a clinical guideline for investigation and management of MTF patients resulted in an increased rate of referral to an Osteoporosis Clinic. This suggests that, among other strategies, the presence of a clinical guideline may increase rates of osteoporosis awareness and referral by clinicians. doi:10.1016/j.bone.2009.01.178
263 Osteoporosis survey: GP management post fragility fracture C.A. Inderjeetha,b, K. Polanda Area Rehab and Aged Care Osborne Park Hospital Program, North Metropolitan Health Service, Nedlands, WA, Australia NHMRC NICS DVA Fellowship Program, Australia Purpose: Patients with fragility fracture secondary to osteoporosis are at risk of recurrent fracture. Osteoporosis (OP) is often under recognised and under treated. A previous study (1), confirmed low rates of awareness, investigation and treatment following fragility fracture. We surveyed General Practitioners (GPs) to assess their attitude to osteoporosis investigation and treatment following a fracture. Methods: GPs were invited to complete a web based survey (Survey Monkey). The survey included questions on GPs attitude to review, informing, investigating, treatment, follow up, referral and responsibility for care of patients following a fragility fracture. Results: A total of 306 GPs have responded so far. Their approach to managing their patients following a fracture are summarised in the table below. There were concerns about short and long term side effects of bisphosphonates (22% and 32%), Strontium Ranelate (27% and 31%) and Raloxifene (20% and 29%). There was a significant association between GP review on discharge and Investigation and initiation of OP treatment (p < 0.05). There was a significant association between the initiation of specific OP treatment and concern re short term side effects of bisphosphonates and Strontium Ranelate (p < 0.05); but not the long term concerns.
GPs who always or mostly:
Percent
Review patients on discharge from hospital Inform patients they have OP Request a BMD to assess patients regularly Their responsibility to investigate patients for OP Commence calcium supplements Commence vitamin D supplements Commence specific OP treatment Consider “other doctor” responsible for OP Refer patient to “other doctor or clinic”
78 84 42 85 83 67 73 22 7
Conclusion: This survey suggests higher rates of review, investigation and treatment of patients by GPs following fragility fracture. This is at odds with published data on rates of patient awareness, investigation