Bone Abstracts

Background: Osteoporotic vertebral fractures are the most common type of fragility fracture, yet they are frequently underdiagnosed despite their association with substantial morbidity, increased mortality, and an increased risk of subsequent fractures. To address the long wait for osteoporosis clinic appointments locally, we established a dedicated multiprofessional clinic designed to assess patients with vertebral fractures promptly and optimise management. Where appropriate, this includes consideration of sequential therapy, initiating treatment with an anabolic agent followed by an antiresorptive to improve clinical outcomes.

Objective: We evaluated outcomes from the multiprofessional vertebral fracture clinic at two separate time points as part of a quality improvement initiative, enabling assessment of service impact and identification of areas for ongoing improvement.

Methods: Retrospective analysis of the vertebral fracture clinic database at 2 time periods (Cycle 1) from November 2024 to March 2025 and (Cycle 2) April to October 2025. Key performance indicators included fracture-to-referral, fracture-to-clinic, and fracture-to-treatment timelines, referral sources, DXA, and treatment.

Results: Cycle 1 included 100 patients (72% female); 70 underwent DXA, with osteoporosis identified in 61%. Cycle 2 included 92 patients (73% female); 56 underwent DXA, with osteoporosis identified in 50%. Following expansion of clinic capacity and referral pathways after the first phase, key outcomes improved. Fracture-to-treatment time decreased from 20.5 to 17.9 weeks, and clinic-to-treatment time from 9.5 to 7.8 weeks. Referrals from medical specialties increased, reflecting better case identification through multidisciplinary engagement and radiology prompts. However, fracture-to-clinic time remained unchanged (10.5 vs 10.9 weeks), and overall fracture-to-treatment time still exceeded the recommended 16-week FLS standard. Treatment rates were stable overall, with increased use of parenteral therapies, particularly zoledronic acid. Approximately half of patients were eligible for anabolic therapy, but only a quarter ultimately commenced treatment, largely due to logistical barriers.

Conclusion: A dedicated vertebral fracture clinic improved the timeliness of assessment and treatment. Anabolic therapy was feasible in approximately a quarter of patients. Further optimisationincluding automated referral pathways, expanded clinic capacity, and stronger primary care engagementis needed to enhance secondary prevention of vertebral fractures.