Patient safety

Fracture prevention rates improved through collaboration

A partnership between the Academic Health Science Network for the North East and North Cumbria (AHSN NENC) and Newcastle and Gateshead CCG has resulted in significantly enhanced fracture prevention rates for the local population and significant savings for the NHS.

Hospital statistics displayed that the North East region of England had a substantial higher occurrence of hip fracture than the average (643 vs 575 per 100,000 population) prompting the AHSN to commence a primary care review to recognise patients at risk of fragility fracture and/or osteoporosis.

Across the North East of England and North Cumbria 71 general practices were involved, representing a registered population of almost 260,000 patients aged over 50.

This project was developed in a Joint Working Agreement with Amgen. The goal of the programme was to develop health outcomes for patients at risk of sustaining a fragility fracture and to highlight developments in bone health through effective treatment, medication compliance and patient education, all reinforced by national guidance and local regional treatment pathways.

The large-scale review undertaken by pharmacists from Interface Clinical Services who worked in partnership with AHSN and CCG, demonstrated that even though risk of fracture and osteoporosis was high, the use of beneficial bone sparing agents was limited.

With more than 20% of the 8,000 patients had a 10-year probability and almost 3,000 patients who required treatment were also identified; approximately 50% of these were not being treated or hadn’t had their bone health fully assessed.  

During case review, clinicians were able to improve bone health by prescribing bone sparing agents (BSA) or optimise the medication of those already taking BSA’s, identify patients at risk of calcium and vitamin D deficiency and establish in education programme to improve the management of patients with osteoporosis.

Within the untreated cohort alone, the 10-year probability of hip fracture predicted 140 hip fractures at a direct hospital cost of almost £2.3 million. With effective treatment, a 40% reduction in hip fracture incidence was predicted in this population resulting in a potential net direct cost savings of approximately £900,000.

Bone Health Programme Manager for AHSN NENC, Sue Hart, commented: “Improvements in bone health can be achieved through a range of non-medical and medical interventions. These might include diet and lifestyle modifications, exercise and mobilisation, bone sparing therapy, calcium and vitamin D supplementation for example.

"Our collaboration with the local CCG and Interface Clinical Services enabled us to identify the patients that needed interventions and we have greatly improved the bone health for many people within our region by preventing long term problems and associated costs. Due to its success, we are working to develop a similar programme which can be delivered through the whole AHSN network."