High-risk osteoporosis clinic (HiROC): improving osteoporosis and postfracture care with an organized, programmatic approach

A programmatic outpatient high-risk osteoporosis clinic (outpatient HiROC) and inpatient fracture liaison service (inpatient HiROC) is described. Results document that this population is more effectively treated and followed up in this specialty pathway than with primary care follow-up.

We describe a programmatic approach to outpatient care of high-risk osteoporosis patients (outpatient HiROC). We similarly describe an inpatient fracture liaison service (inpatient HiROC), which integrates into the existing outpatient HiROC pathway.

The development of outpatient HiROC and inpatient HiROC is described. Outpatient visits (July 29, 2008 to October 27, 2011) are included with a 200 patients random sample calculation. Inpatient consultation visits between November 18, 2008 and October 27, 2011 are included.

Between July 29, 2008 and December 31, 2011, 1917 outpatient consults were seen. Of the 200 patient samples, 87 % were female, mean age of 69.8 years, previous fractures occurred in 34 % patients, and glucocorticoid users constituted 10.6 %. Eighty-six percent of this group was high risk, where drug therapy is indicated, and such treatment was started in 89 %. A total of 1041 inpatient fracture consults were seen during the evaluable period; 14.7 % of this population died before the 6-month follow-up. Females comprised 77.6 %, mean age was 76.1 years, and 58.2 % of fractures were hip fragility, 11.6 % vertebral, and 1.7 % midshaft and 1.6 % subtrochanteric. Patients seen in our outpatient HiROC pathway were significantly more likely to be treated than those followed up by one of our primary care doctors (80.6 versus 32.2 %, P < 0.0001). Mean vitamin D levels at baseline (27.0 ng/mL) improved to 34.6 ng/mL at 6-month follow-up (P < 0.0001).

Our outpatient and inpatient HiROC model is efficient and effective in risk stratifying and treating patients at high risk for fractures.