Fracture prevention: a population-based intervention delivered in primary care

BACKGROUND: Osteoporosis is common, increasing as the population ages and has significant consequences including fracture. Effective treatments are available. AIM: To support proactive fracture risk assessment and optimizing treatment for high risk patients in primary care. DESIGN: Clinical cohort. SETTING: November 2017 to November 2018, support was provided to 71 practices comprising 69 of 90 practices within two NHS CCG areas. Total population 579,508 (207,263 aged over 50). PARTICIPANTS: Fracture risk assessment (NICE CG146) in: males aged 75 and overfemales aged 65 and overfemales aged under 65 and males aged under 75 with risk factorsunder 50 with major risk factors. RESULTS: 158,946 met NICE CG146, 11,961 were coded with an osteoporosis diagnosis (7.5%), of those, 42% were prescribed treatment with a bone sparing agent (BSA). 6942 were assessed to initiate BSA. 30% of untreated osteoporosis diagnosis patients had never been prescribed BSA.Even when prescribed, 1700 people (35%) were for less than minimum recommended duration. 9,784 within the FRAX recommended to treat threshold, 3,197 (33%) were currently treated with BSA and 3,684 (37%) had no history of ever receiving BSA. From untreated patients, expected incidence of 875 fractures over a 3year period (approximately £3.4million). Treatment would prevent 274 fractures (cost reduction: £1,274,045, with prescribing costs: saving £805,145 after 3 years of treatment). CONCLUSION: Under diagnosis and sub-optimal treatment of osteoporosis was identified. Results suggest that implementing NICE guidance and optimising treatment options could in practise is possible and could prevent significant fractures.