Bone Abstracts

Background: Individuals who discontinue anti-osteoporosis medications (AOM) on account of intolerance or treatment failure are at increased risk for additional fragility fractures. Timely AOM switch to a second-line option when a patient is intolerant to first-line recommendations or experiences treatment failure is critical to minimize the risk of further fractures.

Objectives: This audit was conducted at Blackpool Victoria Hospital (BVH) with the following objectives:

1. To describe wait times for AOM re-initiation. 2. To describe factors associated with untimely AOM re-initiation. 3. To make recommendations for reducing treatment delays.

Methods: A retrospective database methodology was utilized. Subjects referred to the osteoporosis clinic between June-July 2024 were identified and case notes were retrieved. Extracted variables were entered into a pre-approved data extraction form.

Results: Fourteen subjects (93%) were referred. Eleven (73.3%) had experienced drug intolerance while three participants (26.7%) had experienced treatment failure. At the time of audit, three subjects declined treatment, and one was an inappropriate referral. Seven subjects (46.7%) had commenced alternative AOMs while four (26.7%) were awaiting treatment switch. One subject had an additional fragility fracture while awaiting AOM re-initiation. Among the seven subjects who had commenced alternative AOM treatment, mean pre-treatment wait time (referral to AOM re-initiation) was 250 days. System (infusion clinic appointment wait times) and subject factors (low vitamin D levels; intercurrent illness and surgeries) were responsible for treatment delays.

Conclusion: This audit demonstrated significant wait times for AOM re-initiation in patients referred to the osteoporosis clinic at BVH. The need for timely initiation of AOMs after an osteoporotic fracture is the most often cited treatment gap; however, as evidenced by this audit findings AOM re-initiation delay increases the risk of additional fragility fractures. Implementation of a fracture liaison service (FLS)- based model of care has the potential to reduce wait times for AOM re-initiation by fostering collaboration between primary and secondary care clinicians with a focus on the prevention of additional fragility fractures.