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Bone Health

Osteoporosis review service launched

To help reduce fractures and improve long-term management in primary care

An osteoporosis therapy review service has been launched to help UK primary care practices improve the long-term management of the condition. The review will be carried out by clinical pharmacists with expertise in medicines management and fracture risk assessment and will focus on identifying patients at high risk of fracture. The aim is to help ensure patients are on the appropriate bone sparing therapy, and identify patients with low adherence to, or clinical issues with, their current treatment. This GP practice therapy review is funded by Amgen as a service to medicine.

The review will be carried out by clinical pharmacists from Interface Clinical Services, in partnership with GPs and other practice staff. The clinical pharmacists will interrogate the practice’s patient database using Interface’s software, in order to identify at-risk patients who may benefit from therapy review, including patients with a diagnosis of osteoporosis and patients with a history of, or at high risk of, fragility fracture.

The pharmacists will then assess individual patient records and make recommendations to the lead GP, who will authorise subsequent patient interventions. Patient interventions could include areview of current treatment or a bone health assessment. A previous project across 20 GP practices conducted by Interface pharmacists in osteoporosis and bone health found that only 23% of high- risk patients were on bone sparing therapy. It is estimated that bone sparing therapy can reduce the relative risk of hip fracture by 40%i.

Osteoporosis leads to nearly 9 million fractures worldwide every yearii, and over 300,000 patients present to UK hospitals with fragility fractures annuallyiii. Fragility fractures are fractures that result from low-level trauma, which would not usually lead to a fracture. Reduced bone density is a major risk factor for fragility fracture. Osteoporotic fractures caused by low bone mineral density include clinical spine, forearm, hip and shoulder fractures.

Osteoporotic fragility fractures can cause substantial pain and severe disability, often significantly reducing a patient’s quality of life. Hip fractures almost always require hospitalisation, are fatal in 20% of cases, and permanently disable 50% of patients. Only 30% of hip fracture patients make a full recoveryiv. Fragility fractures were estimated to cost the NHS £1.8 billion in 2000, and could increase to £2.2 billion by 2025v.


i Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Welch V, Coyle D, Tugwell P. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001155. DOI: 10.1002/14651858.CD001155.pub2
ii Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International 17: 1726–33.
iii British Orthopaedic Association (2007).The care of patients with fragility fracture.
iv  Sernbo I, Johnell O (1993). Consequences of a hip fracture: a prospective study over 1 year. Osteoporosis International 3: 148–53.
v  Burge RT, Worley D, Johansen A, et al. The cost of osteoporotic fractures in the UK: projections for 2000– 2020. Journal of Medical Economics 4: 51–52.

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