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At the heart of general practice since 1960

GP fracture screening cuts falls

By Nerys Hairon

Screening elderly patients for osteoporotic fractures risk can dramatically cut the rate of falls, a primary care study concludes.

The study of 71 GP practices found a programme of assessment, advice and treatment cut the proportion of high-risk patients suffering falls from 45 to 27 per cent.

The researchers said the programme had had a 'dramatic' impact and that they would analyse data on fractures next.

The results are likely to be used by the National Osteoporosis Society in its campaign to get osteoporosis added to the QOF, one if its experts said.

Specialist osteoporosis nurses accessed GP records (see box), and identified women aged over 74 for questionnaire screening. They reviewed 789 at high risk and referred risk assessment results to GPs for appropriate intervention.

In reviews nine to 15 months later, the mean number of falls per person fell from 0.91 to 0.46, and the proportion of patients who were recurrent fallers dropped from 23 to 12 per cent.

Using questionnaire-based risk assessment was simple and could be 'easily' implemented in general practice, the research-ers told the International Osteoporosis Foundation's world congress on osteoporosis in Toron- to, Canada, last week.

Dr Peter Selby, a researcher on the study and consultant physician at Manchester Royal Infirmary, said: 'It's likely NICE will be recommending primary prevention of osteoporotic fractures later this year and therefore the important question isn't whether intervention is feasible, but how it can be achieved in primary care.'

Dr Peter Stott, a member of the scientific advisory committee for the NOS, that ran the project, and a GP in Tadworth, Surrey, said: 'It's an example of why osteoporosis should be in the QOF. This could easily be linked to a local falls service.'

But Dr Iain Gilchrist, a GP with an interest in rheumatology in Hatfield Heath, Essex, said he doubted whether many practices would be able to do similar audits without extra resources.

nhairon@cmpi.biz

How screening worked

· Women over 74 sent postal questionnaire and classed as

at low, medium or high fracture risk using validated assessment tool

· Low/moderate risk patients sent lifestyle advice; those at moderate risk reviewed annually by GPs

· High-risk invited to attend assessments with specialist nurses; fracture risk was

recalculated and advice given on preventing falls and fractures

· GPs informed of patients' fracture risks and advised to consider referral for DEXA scans or medications

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