title: Improving Osteoporosis Management in Primary Care: An Audit of the Impact of a Community Based Fracture Liaison Nurse.
abstract: BACKGROUND
  Osteoporosis and associated fragility fractures are a major health problem; they are more common in women over 50 years old. Fracture liaison nurses have been widely used in secondary care to promote the recognition of fragility fractures and to promote the use of bone-sparing medication to reduce the risk of recurrent facture.
  
  
  OBJECTIVE
  Audit the impact of a primary care based fracture liaison nurse on the detection of fragility fractures in people with osteoporosis and their treatment with a bone-sparing medication.
  
  
  METHODS
  This audit took place in 12 GP practices using 'before and after' cross-sectional extractions of anonymised routine data. We report, for females 50-74 years and ≥ 75 years old, socio-economic deprivation index, the prevalence of osteoporosis, recording of fragility fractures, dual-energy X-ray absorptiometry (DXA), smoking, and body-mass index (BMI) and use of appropriate bone-sparing medication. We used Altman's test of independent proportions to compare before and after data.
  
  
  RESULTS
  Recording of the diagnosis of osteoporosis increased from 1.5% to 1.7% (p = 0.059); the rate of DXA scans fell (1.8% to 1.4%; p = 0.002); recording of fractures and fragility fractures more than doubled (0.8% to 2.0%; p<0.001 and 0.5% to 1.5%; p<0.001, respectively) with approximate doubling of the recording of smoking, and BMI (p<0.001 level). Fragility fracture recording rose from 8.8% to 15% in females aged 50 to 74, and from 0.8% to 2.3% in people aged ≥ 75 years old (p<0.001). There appeared to be inequity in the service, people who were least deprived were more likely to receive DXA scans and the more deprived to be prescribed bone sparing agents.
  
  
  CONCLUSIONS
  A fracture liaison nurse in primary care has been associated with a period of improved management. Liaison nurses based in different parts of the health system should be tested in a prospective trial.
authors: Clinical Informatics, Department of Health Care Policy and Management, University of Surrey, Guildford, Surrey, United Kingdom.
authors: Tom
authors: T
authors: Chan
authors: Clinical Informatics, Department of Health Care Policy and Management, University of Surrey, Guildford, Surrey, United Kingdom.
authors: Simon
authors: S
authors: de Lusignan
authors: Bridge Medical Centre, Three Bridges Road, Crawley, West Sussex, United Kingdom.
authors: Alun
authors: A
authors: Cooper
authors: Bridge Medical Centre, Three Bridges Road, Crawley, West Sussex, United Kingdom.
authors: Mary
authors: M
authors: Elliott
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009731:Nursing Audit; D010024:Osteoporosis / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000628:therapy*; D059017:Primary Care Nursing / Q000592:standards*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014807:Vitamin D / Q000097:blood
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D