Bone Abstracts

It is well known that osteoporotic fragility fractures are an important risk factor for subsequent new vertebral and non-vertebral fractures. Many countries published recommendations to prevent fractures. Also in Italy the Minister of the Health highlighted the importance to prevent osteoporosis and the subsequent fractures, without practical instructions on the management of patients with fragility fractures in the daily clinical practice. Up to date there is no standardized diagnostic and therapeutic pathway (DTP), with a non-homogeneous patient management, different costs and patient outcomes. With the aim to improve the outcome of patients with femoral, vertebral and wrist fragility fractures, a standardized DTP has been created by a multidisciplinary working group (Physiatrist, Orthopedic and quality management control representative) in an Italian hospital. Patients admitted in the Orthopedics Unit with a fragility fracture are identified by a specific ‘patient record’, with prescription of first level blood tests for osteoporosis diagnosis according to the national guidelines. Then a discharge letter is specifically created with the diagnosis of osteoporotic fragility fracture. Patients discharged from orthopedics have a priority access to the rehabilitation unit, where other diagnostic tests are performed (i.e. second level blood tests and others such as X-rays, MRI, etc.). Upon discharge from the rehabilitation unit, a letter is drawn up with the fragility fracture diagnosis, drug prescriptions, according to the National reimbursability criteria. Follow-up visits are required at 6 and 12 months to measure activity, process and outcome indicators, with the objective to verify: i) percentage of DTP implementation. ii) percentage of patients with new fragility fracture occurred within one year from hospital discharge. In conclusion, the working group expectation is the 100% of the DTP application, with consequent patient re-fractured reduction in the 1-year period, compared to the patient fracture incidence without DTP implementation.