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Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre–post study
  1. Fernando Gomez1,
  2. Carmen Lucia Curcio1,
  3. Sharon Lee Brennan-Olsen2,3,
  4. Derek Boersma4,
  5. Steven Phu2,3,
  6. Sara Vogrin2,3,
  7. Pushpa Suriyaarachchi4,
  8. Gustavo Duque2,3
  1. 1 Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
  2. 2 Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Victoria, Australia
  3. 3 Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
  4. 4 Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Gustavo Duque; gustavo.duque{at}unimelb.edu.au

Abstract

Objectives Traditionally, the approach to fracture prevention has focused on increasing bone mineral density while typically lacking a combined clinical approach to falls prevention and vice versa. To resolve this gap, we implemented and evaluated a novel combined model of care to the assessment and prevention of osteoporosis and falls in the outpatients setting.

Setting Falls and Fractures Clinic (FFC) at Nepean Hospital (Penrith, NSW, Australia).

Participants Pre-effects and posteffects assessment of 106 community-dwelling older patients referred from the community.

Primary and secondary outcome measures Previous falls and fractures were recorded. Clinical, functional and paraclinical evaluations were performed. A comprehensive multidisciplinary care plan was then tailored based on the presence of risk factors. Six-month follow-ups were performed assessing the incidence of falls and fractures, change in risk factors for falls and level of risk, with the recommended plan.

Results We report that 97% of patients had a fall in the preceding 6 months, 47.6% of whom experienced a fracture from the fall. Furthermore, 64% of patients had a marked risk for falling by Physiological Profile Assessment (PPA), 90% had intermediate–high 10-year probability of fracture according to FRAX and 78% had sarcopenia. At 6-month follow-up, we observed more than an 80% reduction in falls and recurrent falls, and 50% reduction in fractures. In addition, 65% of patients had reduced PPA and a 57% reduction in 10-year fracture probability.

Conclusions In conclusion, we suggest that a multidisciplinary FFC can provide substantial reductions in falls and fractures for high-risk older people, even over a relatively short 6-month time period. The current model of service provision via traditional falls clinics could be significantly improved by encompassing fracture prevention within the multifactorial approach to interventions.

  • falls
  • fractures
  • osteoporosis
  • falls and fractures clinic
  • osteosarcopenia

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors FG, CLC, DB, SP, PS and GD generated, analysed and interpreted the patient data regarding the clinical and pathology results. SV and SLB-O performed the statistical analysis, and were major contributors in writing the manuscript. All authors read and approved the final manuscript.

  • Funding This study was funded by a grant from the Australian Institute for Musculoskeletal Science. SLB-O is supported by a Career Development Fellowship from the National Health and Medical Research Council of Australia (1107510). FG is supported by an Australian Leadership Award Fellowship from Australian Government Overseas Aid Program.

  • Competing interests None.

  • Ethics approval This study was approved by the Nepean Blue Mountains Local Health District Human Ethics Research Committee (Reference number HREC/11/NEPEAN/94).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

  • Patient consent for publication Not required.

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