New model of care to help prevent serious fractures in higher risk patients

Serious fractures, especially hip fractures, are a consequence of osteoporosis and all too common among our elderly population in Canada. For an elderly patient, a serious fracture often means a long stay in hospital and being unable to return to the life they had before being injured.

A new model of care has been developed between Osteoporosis Canada and North York General Hospital’s (NYGH) Elder Care, Medical Imaging and Ambulatory Care programs to help prevent repeat fractures among high-risk patients.

Most hip fractures occur in people over 70 years of age, and incidence rises exponentially with increasing age. Hip fractures in elderly people are associated with poor clinical outcomes, including higher mortality rates (10 to 28% at six months), and functional and walking disabilities.

Fewer than half of patients regain their pre-fracture abilities; with up to 35 per cent of patients, who were living at home, admitted to a nursing home within one year after a hip fracture.

Led by Dr. Gabriel Chan, the new model was developed after reviewing data that showed 10-15 years after a minor fracture, patients were much more likely than the rest of the population to suffer a hip fracture.
“Traditionally, a hip fracture has been the trigger for health care providers to explore the reasons why a patient suffered such a serious fracture, but now that we know earlier minor fractures indicate a risk of more severe injury in the future, we should focus on prevention and early treatment,” says Dr. Gabriel Chan, Director of Elder Care at NYGH.

In this new model of care, NYGH’s Orthopaedic Surgeons refer patients over age 50 with a minor fracture for a bone mineral density scan. After an initial assessment of the patient’s fracture risk, a letter is sent to their primary care provider with instructions for follow-up care.  Patients who are determined to be medium to high risk of a repeat fracture are referred to NYGH’s Osteoporosis and Fracture Prevention Clinic, which provides comprehensive assessment and diagnosis, and determines treatment plans for falls and osteoporosis.  The clinic links day hospital patients with occupational therapists, physiotherapists, educational programs and home care services.

“This model creates a process where at-risk patients are identified early and creates collaboration between patients various health care providers, improving the continuity of care and early intervention.  In the end, patients will have better long term outcomes,” says Bibi Rampersad, Clinical Team Manager of Ambulatory Services at NYGH.

“There are many misconceptions about osteoporosis, like only the very elderly and frail could possibly have the disease,” says Ravi Jain, Director of the Ontario Osteoporosis Strategy. “The new assessment and prevention model at North York General is unique because it identifies osteoporosis earlier, increasing a patient’s access to treatment options and implementing fracture prevention strategies with all members of a patient’s health care team.  This model really is the new best practice in preventing future serious fractures.”

By intervening early, models of care like this one, can prevent patients from suffering a serious fracture in the future and helps patients maintain a better quality-of-life in their later years.