Intravenous bisphosphonate use predominates in a hospital-based bone telehealth rapid access clinic service (Bone-TRACS) resulting in retained hospital specialist care — ASN Events
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Intravenous bisphosphonate use predominates in a hospital-based bone telehealth rapid access clinic service (Bone-TRACS) resulting in retained hospital specialist care (#384)

Abraham Shamshad 1 , Mervyn Kyi 1 2 , Christopher Yates 1 2 , Spiros Fourlanos 1 2
  1. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  2. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia

Increasing numbers of patients with osteoporosis are referred to specialist bone clinics. Osteoporosis medication selection is influenced by fracture history, bone mineral density (BMD), age, prior therapy, feasibility of medication delivery and patient preference. We aimed to assess medication treatment patterns and associated clinic outcomes in patients receiving a hospital-based bone telehealth rapid access clinic service (Bone-TRACS) model-of-care (maximum three specialist clinical encounters).

We performed a retrospective audit of 210 patients with osteoporosis who received a medication treatment change in the Bone-TRACS model-of-care. Patients were compared by selected therapy for clinical characteristics, BMD and discharge destination.

Intravenous bisphosphonate was the dominant treatment pathway, prescribed in 118 patients (56%), followed by oral bisphosphonates in 65 (31%), denosumab in 21 (10%) and anabolic therapy in 6 (3%). Denosumab recipients were older (mean 81.6 years) and had the lowest mean neck of femur (NOF) T-score (−2.50) with mean total hip and lumbar spine T-scores of −1.94. Anabolic therapy recipients (romosozumab or teriparatide) all had prior fracture, with mean NOF and lumbar spine T-scores of –2.1 and −1.42 respectively. Zoledronic acid recipients had mean NOF and lumbar spine T-scores of −2.14 and −2.12 respectively, and among those with follow-up DEXA demonstrated modest T-score improvements at the lumbar spine (+0.21) and total hip (+0.28). Despite not having the lowest average NOF BMD, zoledronic acid recipients had the highest ongoing hospital-based specialist bone clinic follow-up post Bone-TRACS (77%) with only 11% discharged to primary care. In comparison, 67% of denosumab recipients and 43% of oral bisphosphonate recipients were discharged to primary care.

Intravenous zoledronic acid use was associated with disproportionate retention in hospital-based specialist medical care for follow-up. Given the increasing burden of osteoporosis in the community and hospital clinics, we recommend considering nurse-led infusion centres to reduce the burden on specialist bone clinics.