AB0612 THE FRACTURE PREVENTION UNIT OF THE VIRGEN MACARENA HOSPITAL REDUCES THE GAP IN THE MANAGEMENT OF OP, PARTICULARLY IN MALES AND MEETS IOF/ESCEO QUALITY STANDARDS
Authors: Hernández-Cruz B. , Olmo Montes F. J. , Miranda García M. J. , Jimenez Moreno M. D. , Vázquez Gómez M. A. , Giner García M. , Colmenero Camacho M. A. , Pérez Venegas J. J. , Montoya García M. J. 
Published: May 2021

Background:

The Virgen Macarena University Hospital belongs to the Public Health System of Andalusia and serves 481,296 inhabitants in Seville, Spain. In 2018 the Fracture Liaison Service switched to a multidisciplinary unit.

Objectives:

To describe FLS, to know the characteristics of patients with emphasis on gender differences and to know the completion of International Osteoporosis Foundation quality standards.

Methods:

Prospective, observational, analytical, research of usual clinical practice. All the consecutive patients attended from May 2018 to October 2019, ≥50 years, with a fragility fracture (occurred in the previous 24 months) were included. The study was approved by the Ethics Committee, Code 1084-N-16.

Results:

Our FLS is a type A multidisciplinary Unit, with a high level of intervention in the evaluation, estimation of fracture risk and fall risk, treatment prescription and follow-up of the patients. We included 408 patients, 80% females, one third with ≥80 years. Fragility fractures recorded in 328 women were hip (132, 40%), clinical vertebral (81, 25%) and no hip no vertebral (115, 35%). Those recorded in 82 males were hip (53, 66%), clinical vertebral (20, 24%) and no hip no vertebral (9, 10%), p=0.0001. Males had a higher rate of secondary causes of OP, drinker, and smoking. The most relevant gender difference was the low percentage of patients receiving pre-FF OP treatment. Forty-nine (16%) women versus 9 (7%) males had received it at some point in their life, p=0.04. Two hundred and seventy-one (86%) women vs 48 males (63%) had received it at after their FF in their reference unit, and all them were treated after the FLS evaluation. The probability of a male not receiving prior treatment was 2.5 (95% CI 1.01- 6.51); p=0,04. This probability was 0.64 (0.38-1.09) after the FF. After twelve months of follow-up in FLs, 96% continued treatment, with no differences between men and women. The completion of IOF quality standards was bad (red light) for patient identification items and FLS reference time. It was poor (amber traffic light) for initial OP screening standard and was good (green light) for the remaining 10 indicators. The completion of IOF quality standards was bad (red light) for patient identification items and FLS reference time. It was poor (amber traffic light) for initial OP screening standard and was good (green light) for the remaining 10 indicators (Figure 1).

Figure 1.

Figure 1.

Conclusion:

The FLS is a multidisciplinary type A. Its operation has narrowed the gap in diagnosis, treatment, and follow-up of FF patients, especially males. It is essential to improve patient recruitment, reduce referral times and increase the overall assessment of the patients.

References:

[1]Ganda K. et al. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis, Osteoporos Int 2013;24:293-406.

[2]Javaid MK et al. A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network. Osteoporos Int. 2020 Jul;31(7):1193-1204.

Acknowledgements:

Spanish Society of Research in Mineral and Bone Metabolism for its support through the competitive project FLS Excellence 2018 to obtain a training grant from the case management nurse.

Disclosure of Interests:

Blanca Hernández-Cruz Speakers bureau: Sociedad Española de Reumatología, Abbvie, Roche, Bristol, MSD, Lilly, Pfizer, Amgen, Sanofi, Consultant of: Abbvie, Lilly, Sanofi, STADA, UCB, Amgen, Galapagos., Grant/research support from: Fundación para la Investigación Sevilla, Junta de Andalucía

Fundación Andaluza de Reumatología, Sociuedad Española de Reumatología., Francisco Jesús Olmo Montes: None declared., Maria José Miranda García: None declared., María Dolores Jimenez Moreno: None declared., María Angeles Vázquez Gómez: None declared., Mercedes Giner García: None declared., Miguel Angel Colmenero Camacho: None declared., José Javier Pérez Venegas: None declared., María José Montoya García: None declared.