Authors (including presenting author) :
Pui-kwan Chan , Vincent WS Li, Yim-chu Li, Catherine XR Chen
Affiliation :
Department of Family Medicine & Primary Healthcare, Kowloon Central Cluster, Hopsital Authority, Hong Kong
Introduction :
With a rapidly aging population, osteoporosis is becoming a major health problem in Hong Kong. Its importance lies in its predisposition to fragility fractures, which causes significant morbidity and mortality to the elderly. Despite the heavy economic and social burden to society, management of osteoporosis is far
from ideal. We believe family physicians in Hong Kong can also take on an active
role in combating osteoporosis. Therefore, a dedicated multidisciplinary
osteoporosis clinic (MOC) was set up in Yau Ma Tei Family Medicine Specialist Clinic (FMSC) in 2010 at Kowloon Centre Cluster. In MOC, osteoporotic patients were invited to a health talk on osteoporosis and then an individual counselling session by nurse, followed by doctor consultations which were conducted by trained family physicians. Dietitian counselling, physiotherapy and occupational therapy was included in the management plan if needed.
Objectives :
This study aims to evaluate the clinical effectiveness of MOC, in terms of DEXA T-score improvement of osteoporotic patients.
Methodology :
Study Design:
Retrospective case series study conducted in a FM (Family Medicine) clinic in the public setting Subject
Inclusion criteria:
All osteoporotic patients, coded by International Classification of primary care (ICPC) L95 (osteoporosis), who had attended MOC of the Department of FM & GOPC, KCC from 1 January 2015 to 31 December 2018.
Primary outcomes:
1. Changes in DEXA T-score of recruited osteoporotic patients after two years of management at MOC.
2. Subgroup analysis: 2-year interval DEXA T-score changes among patients with or without history of fragility fracture; and among patients with or without pharmacological treatment
3. Serial interval DEXA T-score changes of recruited patients who had completed 5 years of bisphosphonate
Secondary outcome:
The occurrence of new osteoporotic fracture of recruited osteoporotic patients
Result & Outcome :
In the final data analysis, 186 patients were included. The mean baseline DEXA T-score of lumbar spine and femoral neck were -2.71±0.76 and -2.40±0.75 respectively. While the FRAX score was 10.3±8.0% for major osteoporotic fracture and 4.0±5.3% for hip fracture. After 2 years of management in MOC, T-score of recruited patients improved from -2.71±0.76 to -2.35±0.83 at lumbar spine, and from -2.40±0.75 to -2.10±0.76 at femoral neck, which were both statistically significant (P<0.001). Subgroup analysis of patients with a history of fragility fracture showed that the baseline T-scores were lower at both the lumbar and femoral neck region compared to those without any history of fragility fracture, which were -2.96±0.77 and -2.57±0.72 respectively. Improvement in T-score of both lumbar (P<0.001) and femoral neck (P=0.0017) were significant at 2-year follow up. For those without a history of fragility fracture, improvement in T-score of both lumbar and femoral neck were also observed (P<0.001). Among the 186 patients, 153 of them (82.7%) received osteoporosis drug treatment, namely bisphosphonate via the MOC. While 33 of them (17.3%) had not received drug treatment and were on life style modifications. Subgroup analysis of those who received pharmacological treatment showed significant improvement in the T-scores of both lumbar and femoral neck (P<0.001). While those who were on lifestyle modifications without drug treatment also enjoyed T-scores improvement at both lumbar spine (P<0.001) and femoral neck (P=0.025). During the follow up period, 46 patients received and completed 5 years of bisphosphonate therapy. Progressive improvement in T-scores of both lumbar and femoral neck were observed. Regarding the secondary outcome, 1 out of the 186 osteoporotic patients suffered from a new osteoporotic fracture within the 2-year follow-up period. The incidence rate was 2.7 cases per 1000 person-years. This patient suffered from a left hip fragility fracture after two years of oral alendronate.
