This site uses cookies to store information on your computer. I'm fine with this Cookie information

Osteoporosis Service

osteoporsis image GG&C Osteoporosis Service Website - A guide for service users. Comprehensive description of the Fracture Liaison Service (FLS), Direct Access DXA Service (DADS), Secondary Care DXA Service (SCDS), and also of the Bone / Mineral Metabolism Clinics - with description of how these services function - their aims & objectives - and how users can get the most out of these services.


What services are available for patients with osteoporosis in GG&C?

GG&C Health Board provides a comprehensive range of osteoporosis services that aim to reduce the incidence of osteoporotic fractures (see table beloe). These services encourage prioritisation of patients who are at highest risk of fractures – for assessment and treatment for secondary fracture prevention (for patients with new fractures via FLS and FLSradiology, and for patients with previous fractures via DADS & SCDS). Patients who have not yet sustained a fracture but who are at high risk can be assessed for primary fracture prevention via DADS & SCDS.

Where are the osteoporosis services located?

Service (click on required service to access more detail)

Aim:

Fracture Liaison Service (FLS)

Routine assessment of re-fracture risk & for the need for treatment for prevention of secondary fractures, for all women & men ≥50yr who present with a new fracture to orthopaedics or to A&E.

FLSradiology

Routine assessment of re-fracture risk & for the need for treatment for prevention of secondary fractures, for all women & men ≥50yr who have a newly reported fracture of spine (or other site) identified from Radiology reports.

Direct Access DXA Service (DADS)

 

Assessment for osteoporosis and fracture risk in patients referred by GPs or AHPs on the basis that they have ≥1 agreed specific referral criterion. Criteria incl. past history of fracture & steroid treatment.

Secondary Care DXA Service (SCDS)

 

Assessment for osteoporosis in patients referred by secondary care clinics on the basis that patients have ≥1 agreed referral criteria (risk factors for osteoporosis).

Bone / Mineral Metabolism Clinics

 

Assessment of patients at risk of osteoporosis & other metabolic bone disease referred by GPs & secondary care clinicians – where these patients are not suitable for the services described above. Patients with particularly severe or complex osteoporosis identified via FLS / DADS / SCDS are referred automatically to the Bone / Mineral Metabolism Clinics.

Patient Education Meetings

All patients processed by FLS & DADS whose fracture risk necessitates treatment are invited to attend a 2-3hour education programme. The aim is to empower patients and to encourage adherence to treatment & exercise regimens.

Physiotherapy Service for Osteoporosis, & the Community Exercise services

Page only available on StaffNet for now.

Patients referred from the range of sources above will receive specific physiotherapy assessments, and are given individualised treatment and advice on Osteoporosis generally and exercise specifically.  Treatment options include referral to 12-week Physio-led introductory exercise classes, or to local leisure centre-based classes run by Culture & Sport Glasgow.

Other

Day-ward intravenous bisphosphonate service via endocrine day units

Osteoporosis clinical research – undertaking contract research in association with R&D department.

What is the aim of the osteoporosis services?

The aim is to assess whether patients are at sufficient risk of fracture to require treatment. Fracture risk is primarily determined by assessment of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA scanning), in the context of age and gender and also of past history of fracture (over age of 50yr).

Fracture risk is modifiable using treatments for osteoporosis – when BMD is reduced to around the level that is consistent with osteoporosis, or lower. The GG&C treatment protocols are consistent with recommendations of SIGN 71: The management of osteoporosis and with NICE TA87.

Other risk factors also contribute to future fracture risk – and many of these are risk factors for falling – some of which are also amenable to intervention; fracture risk that is determined by falls-related risk factors may be modifiable, but not typically using osteoporosis drugs.

The WHO has recently published FRAX- a fracture risk calculation tool. This can aid case-finding for referral to the osteoporosis services – but the GG&C Osteoporosis Subgroup does not recommend using FRAX for initiation of osteoporosis treatments if DXA has not been performed, and if BMD has not been show to be significantly reduced (below a T-score of <-2).

 

FLS

FLSradiology

DADS

SCDS

Bone / Min Met clinic

Inverclyde Royal Hospital

Yes

Yes
Yes
Yes

Yes

Royal Alexandra Hospital

Yes
Yes
Yes
Yes
Yes

Royal Infirmary

Yes

Yes

Yes

Yes

Yes

Southern General Hospital

Yes

Yes

Yes

Yes

Yes

Stobhill Hospital

No

Yes

Yes

Yes

Yes

Western Infirmary

Yes

Yes

Yes

Yes

Yes

Who manages the GG&C osteoporosis services?

The GG&C Osteoporosis Subgroup (of the Osteoporosis & Falls Strategy Group) is responsible for the day to day management of these services. Membership of this group is listed in table. However, the Osteoporosis & Falls Strategy Group which is chaired by Ms Anne Harkness of the Rehabilitation & Assessment Directorate has overall strategic and financial responsibility for the services.

Does the GG&C Osteoporosis Service have treatment protocols?

Yes – and the following protocols can be downloaded from the resources page :

Glucocorticoid-induced osteoporosis
What to do if a patient develops dyspepsia on starting alendronate

Bone protection in patients treated with aromatase inhibitors