Endocrine Abstracts

Background: Osteoporotic fracture risk is doubled in patients with recent fracture; however, post-fracture treatment rates remain dismal. Fracture Liaison Services (FLS) aim to close the secondary prevention ‘gap’ and reduce fracture risk. This study evaluates the efficacy of a computer algorithm-supported, Nurse Practitioner-managed FLS developed in Wolfson Medical Center (WMC).

Methods: A computerized decision-making algorithm was developed using zoledronic acid as the default medication, and recommending endocrinology consultation for patients younger than 65 years, with estimated glomerular filtration rate (eGFR)<35 or prior osteoporosis therapy. The algorithm is performed by a Nurse Practitioner. Patients with vitamin D deficiency/insufficiency are given a loading dose. This retrospective study assesses utility of the algorithm in hip fracture patients hospitalized in WMC between 01/04/2023-31/10/2023.

Results: Two-hundred and eight hip fractures were identified. The cohort was predominantly female (137/208,65.9%); mean age was 79.9±9.6 years. Nurse practitioner evaluation was performed in 200/208 patients (96.2%). The algorithm provided a treatment recommendation in 140/200 (70.0%), while 60/200 (30.0%) required endocrinology consultation due to prior therapy )31/60,51.7%), low eGFR (20/60,33.3%), and/or age below 65 years (12/60,20.0%). Patients requiring endocrinology consultation were more likely to be female. Vitamin D deficiency/insufficiency was present in 161/202 (79.7%), and loading dose given in 89/99 (89.9%) deficiency and 44/62 (71.0%) insufficiency cases.DiscussionThis streamlined algorithm-based, FLS model was practical and functional; the algorithm provided therapeutic recommendations in 70% of cases without need for physician intervention. Simplified FLS interventions requiring minimal healthcare worker loads are feasible and hold promise for resource-poor healthcare settings.