Introduction: Osteoporotic fractures represent a considerable and growing burden to patients, society and health-care financing. Although several initiatives in hospital setting (clinical pathway, guidelines, dedicated personnel for consulting) have been reported to improve clinical osteoporosis management, recent data from different
countries, including Switzerland [1], have shown that after a low trauma fracture, osteoporosis remains frequently undiagnosed and untreated. In the best cases, only 10 to 25% of patients have an adequate diagnosis workup and are adequately treated. The creation of the DAL (Département de l'Appareil Locomoteur) at the CHUV in Lausanne was a good opportunity to create a specific bone disease unit and to implement a new concept based on a systematic handle of all patients during and after the hospitalization for osteoporotic fracture.
Methods: Thanks to the close collaboration with the traumatologic surgeons, medical doctors from the bone disease unit have a direct access to patients with suspected osteoporosis related fracture. Subsequently, patients admitted for a fragility fracture in the trauma unit are identified by a nurse according to a predefined questionnaire
and are then clinically evaluated by the doctor. Upon the results of the clinical examination, a systematic adequate management is proposed to the patients (laboratory tests, DXA, calcium, vitamin D, specific antiosteoporotic drugs) and this, during the acute hospital stay. This management also included a follow-up proposition witch could be
done by either the bone disease unit in the outpatient clinic of the DAL or by the usual practitioner of the patient. During the follow-up, clinical and biological parameters and adherence to the treatment are evaluated. The impact on quality of medical care of these measures will be prospectively assessed.
Results: After 5 months, 250 consecutive inpatients (women 70%, men 30%, mean age 72 years, hip fractures 33%) were evaluated by our team (specific bone unit). Primilary results showed that the great majority of the patients have adhered to the diagnosis workup, the treatment and the follow up in the outpatient clinic. In addition, the
level of satisfaction of patients was excellent. More detailed results will be presented (type of fracture, evaluation of biologic parameters during the hospital stay and after 3 months and one year, adherence to the treatment and the follow up). However, as today, we have already identified 2% of all inpatients with secondary cause of osteoporosis (multiple myeloma, metastasis, primary hyperparathyroidism), indicating the importance of clinical evaluation by a bone specialist.
Conclusion: This new approach based on direct and systematic management of patients likely suffering of osteoporotic related fracture, improved considerably the detection of patients at high risk. This approach is about to be extended to the ambulatory patients.