Our services

Aims

Our service strives to provide the best care for everyone, aged 50 and above in Oxfordshire, who is living with osteoporosis. The team aims to ensure that all patients have an individual care plan and are prescribed bone strengthening medication where appropriate. We work closely with Oxfordshire GPs and other teams within the Banbury and Oxford hospitals, allowing us to identify those at risk of osteoporosis.

When our service operates

The service operates 9.00am - 5.00pm Monday to Friday, excluding Bank Holidays.

Who can access our service

The Fracture Prevention Service is available for all men and women, aged 50 and above in Oxfordshire, who have broken or fractured a bone (excluding fingers, toes, skull), where the circumstances of the injury mean that you would not normally expect a broken bone (e.g. falling over from standing height).

The Metabolic Bone Service is available for anyone with suspected osteoporosis arising from another condition or treatment (e.g. thyroid, steroid treatment).

How to access our service

The Fracture Prevention Service identify patients through a variety of channels.

• We review all daily and weekend ward admissions (Horton General Hospital and John Radcliffe Hospital) and check those admissions for fractures.
• We review the weekly trauma outpatient follow-up clinics at the John Radcliffe Hospital and identify those 50+ attending with a fracture.
• We review the weekly trauma outpatient follow-up clinics at the Horton General Hospital and identify those 50+ with a fracture.

We will see people for an assessment during their stay in hospital where possible. For those attending outpatient appointments we will first make contact and introduce ourselves, and will then either perform the assessment at the time (where patients are over 75), or (where patients are between 50 and 75) we will invite patients to attend a dexa appointment and will then follow up with an assessment in a community clinic (see our clinics), if appropriate.

To access the Metabolic Bone service, GPs need to refer into the consultant clinics in writing.

The assessments we perform

We will perform an assessment in which we take a detailed history; this includes information about fractures (current and previous), family history, any history of falls, current lifestyle and mobility, calcium intake, current medication, any previous treatment for osteoporosis as well as looking at other specialist areas (e.g cardiac/vascular, gastrointestinal, malignancy, mental health, renal, rheumatology, endocrinology).

We also perform a physical examination for kyphosis (curving of the spine) and of assessment strength and balance.

The diagnostic tests we perform

We routinely take blood and the results will inform us to recommend the most appropriate bone strengthening medication. We will take blood whilst patients are inpatients or attending trauma outpatient appointments. If we are seeing patients in the community, we will ask them to attend their GP surgery to have blood taken.

For those patients entering the service between the ages of 50 and 75, we will perform a DEXA scan at an outpatient appointment, which will tell us the density of the bones.

Recommending a care plan and referring on

Once we have all the information we need from the test results and assessment, we will recommend a plan of care (which includes diet and lifestyle advice) and usually a bone strengthening medication, which might be an oral medication, regular injections or regular infusions. We work closely with GPs, and, after the initial contact with us, we ask GPs to continue the course of treatment for oral medications and injections.

We might decide the best course of action is for patients to be referred into the Metabolic Bone Clinic, to be seen by a consultant. We might also decide that patients would benefit from being seen by the Falls Team, who can provide additional support and classes in strength and balance, or by physiotherapy and so will discuss this with the patient before making the referral.

Monitoring and following up

The Fracture Prevention Service will telephone all patients with a care plan to follow up after the first three months, to see how they are getting on with their care plan. We are assessing for compliance with medications, checking for side-effects, asking about any recent falls, talking about calcium intake and so on. Where we identify that a care plan is not appropriate or the patient is having trouble following it, we may follow up with an additional community appointment or inform the GP of any observations. We aim to ensure that those at risk are receiving an appropriate intervention that can ultimately help prevent a secondary fracture.