Canada | Osteoporosis

Osteoporosis Exemplary Care Program, St. Michael’s Hospital, Toronto

In 2002, the orthopaedic unit at St. Michael’s Hospital in Toronto hired an osteoporosis coordinator to identify patients with a fragility fracture and to coordinate their education, assessment, referral, and treatment of underlying osteoporosis. The Osteoporosis Exemplary Care Program (OECP) provided secondary preventive care to fracture patients managed in both the in- and out-patient settings.

Four hundred and thirty fracture patients were evaluated during the first year of operations (276 out-patients and 154 in-patients). Almost all (96%) of these patients received appropriate osteoporosis care:

80 out-patients (36%) were treated for osteoporosis prior to assessment by the OECP
124 out-patients (56%) were referred to the Metabolic Bone Disease Clinic or to their GP for osteoporosis treatment
31% of the 128 in-patients were treated for osteoporosis prior to assessment by the OECP
Treatment was initiated for a further 24% of in-patients and another 34% were referred to the Metabolic Bone Disease Clinic or their GP for post-discharge consultation on osteoporosis treatment

A cost-effectiveness analysis of the OECP concluded that a hospital that hired an osteoporosis coordinator who manages 500 patients with fragility fractures annually could reduce the number of subsequent hip fractures from 34 to 31 in the first year, with a net hospital cost savings of CN$48,950 (Canadian dollars in year 2004 values), with use of conservative assumptions. Sensitivity analysis indicated a 90% probability that hiring a coordinator costs less than CN$25,000 per hip fracture avoided. Hiring a coordinator is a cost-saving measure even when the coordinator manages as few as 350 patients annually. Greater savings were anticipated after the first year and when additional costs such as rehabilitation and dependency costs are considered.