Bone Abstracts

Background: The Fracture liaison (FLS) and osteoporosis services at the West Middlesex University hospital are primarily nurse-led, delivered by a full-time FLS nurse and 0.6 WTE specialist osteoporosis nurse. This is overseen by a Rheumatology consultant. Both services are extremely busy with 1,370 patients identified through the FLS in 2024. Despite the development of a novel AI approach to identification and assessment of FLS patients, the service remains significantly understaffed with a waiting time of 9 to 12 months for new non-urgent consultant appointments in the osteoporosis clinic. There is increasing pressure on the specialist nurse to deliver timely follow-up for parenteral osteoporosis therapies.

Method: A specialist pharmacist was introduced for 1.5 days per week including one weekly remote outpatient clinic. The pharmacists role included the assessment and continuation of parenteral treatment for hip and vertebral fracture patients who received their first treatment as inpatients. They co-ordinated the use of anabolic agents in patients with severe osteoporosis where urgent anabolic treatment is indicated. In addition, the specialist pharmacist helped to educate patients about osteoporosis treatments.

Results: Over a 12 month period, the specialist pharmacist saw 54 new patients (predominantly post hip fracture) allowing the consultant to see high-risk urgent new patients sooner. They also saw 111 follow-up patients, alleviating pressure on the specialist osteoporosis nurse. This generated ~26,000 in income for the Trust. The pharmacist independently prescribed parenteral treatments (Zoledronate and Denosumab) where clinically appropriate, improving overall service efficiency.

Conclusion: The introduction of a specialist pharmacist to the FLS and osteoporosis services led to significant improvements in efficiency, allowing patients at high risk of further fractures to be assessed and treated sooner and with significant cost benefits to the Trust. The pharmacist played an important role in patient education aiming to improve compliance with therapies.