BRIDGING THE GAP IN OSTEOPOROSIS CARE: PROVIDING COMPREHENSIVE INPATIENT AND OUTPATIENT OSTEOPOROSIS CARE IN THE RURAL HOSPITAL SETTING

Osteoporosis is a condition causing bones to become weak and this often results in fractures of the arm, hip, spine and pelvis. This can result in devastating injuries to the patient and significant cost to the health care system. According to the government of Canada 2021, there is a significant gap between the recommended care practices and the care provided. Closing this gap would help lower the health impacts and deaths associated with osteoporosis-related fractures, especially with hip fractures, and help prevent future fractures1-3. The proposed research will examine the reasons behind the care gap in osteoporosis management and treatment in the rural Ontario community setting. It will explore the different challenges and barriers faced by patients, healthcare providers and policymakers in delivering optimal care for osteoporosis patients. The study will also evaluate the current interventions in place to address the care gap and identify their strengths and weaknesses. We will explore various strategies aimed at improving osteoporosis management and treatment such as developing a comprehensive osteoporosis care (COC) pathway to enhance patient education, implementing evidence based guidelines, increasing awareness among health care providers and leveraging technology to improve access to care. The purpose of this project is to create a comprehensive osteoporosis care (COC) pathway for inpatients and outpatients in the rural hospital setting. The COC care team includes an orthopaedic surgeon, gynecologist, family physician, kinesiologist, educator, Osteoporosis Canada representative and a public representative.There will be two entry points for at risk inpatients to enter the comprehensive osteoporosis care pathway. When patients present in the emergency room for compression fractures of the spine, hip and pelvic fractures. These patients will be identified and the COC team will be notified. The second point of entry is when hip fractures from outside facilities are directly admitted to the orthopaedic surgery service, these patients will be identified by the surgeons and COC team will be notified. The goal is to capture patients who present to the hospital for hip, pelvic and spine fractures. These patients will be screened and appropriate investigations will be initiated. Patients and their family members will be educated on osteoporosis management options. When appropriate, their treatment will be initiated. The outpatient pathway is through the ambulatory fracture clinic. The osteoporosis nurse will screen patients identified to have suffered a fragility fracture. The patients identified as at risk will be connected to the COC team. We will partner with community organizations such as senior centers to educate and raise awareness about osteoporosis. We will also partner up with community rehabilitation facilities to provide Bonefit exercise programs to help improve bone and muscle strength as well as balance to prevent falls. We will have a contact person for the physicians to refer at risk patients to the COC team. Once the COC team is contacted, we will screen the patient for possible osteoporosis. The screening will follow the current FRAX scoring system4. Once the patient has been assessed, pending on their relative risks, they will be directed to the treatment pathways for future fracture prevention. The Comprehesive Osteoporosis Care team was effective in closing care gap by comparing the number of at risk patients identified and treated by the COC team intervention to the previous years. Patients expressed high satisfaction scores in their care. There has been a high adherence rate at 6 month follow-up survey on the continuum of lifestyle changes, nutritional changes, exercises, and pharmaceutical treatments. Closing the care gap in osteopoprosi reguires a comprehensive approach encompasing pbulic education, improved access to care, enhanced are coordination. By implementing a multifaceted approach that combines these strategies, healthcare systems and policymakers can effectively address the barriers preventing proper assessment and treatment of osteopposis leading to impvoedm outcomes for at risk individuals.