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Osteoporosis

 

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About half of all women aged 50 or above will suffer at least one broken bone. Osteoporosis can also affect men, and rarely, children.

The osteoporosis service at University Hospitals Bristol aims to help clinicians identify those people most at risk of low impact fractures (breaks) and then manage them appropriately with a combination of education, physical therapy and drugs. 

 Our service is based in the Rheumatology Unit. Our

multidisciplinary team is led by Dr Shane Clarke, consultant rheumatologist. Dr Roopa Prasad and Dr Matt Roy also carry out clinics for patients with osteoporosis and there is registrar cover. The team is supported by an osteoporosis specialist nurse, physiotherapy and patient education. We have access to a full set of laboratory and imaging services.

What we offer

Direct Access DXA scans: Patients at relatively high risk of fragility fracture can be referred for a DXA scan by their GP. The reports are all written or checked by a consultant and provide clinical advice for the referrer. Patients are offered copies of their scan results. Commissioning Guidance is available here or, for the Direct Access Referral form click here.

More complex patients, or those that have not tolerated oral therapies, may be referred for outpatient assessment. According to need, some of these patients may be suitable for the "one-stop" osteoporosis clinic where a clinician will review the patient with the results of a scan carried out immediately beforehand, in the department. To refer a patient to the osteoporosis clinic, either write to Dr Shane Clarke, Consultant Rheumatologist:Fax 0117 342 3841 or call 0117 342 2905 or click here for a referral form.

Parenteral therapies: Although initial drug treatment is usually oral medication, sometimes this is unsuitable and alternatives are required. These may include:

  • IV bisphosphonate therapy Our infusion clinic runs daily for patients requiring intravenous (zoledronate) bisphosphonate therapy. To find out more about this treatment, click here.
  • Subcutaneous denosumab is given by six-monthly injections for patients at high risk of fracture. Denosumab injections are usually first given in our department with subsequent doses administered in general practice. Click here for shared care guidance.
  • Teriparitide: This anabolic drug is administered subcutaneously, daily, over a two year period. It is available for patients at high risk of fracture who fulfil predefined (qualifying) criteria.

Patient Education

The team provides osteoporosis patient education programmes for patients with osteoporosis or at increased risk of fracture who want to learn more about the condition.

The sessions involve input from our nurse specialist, physiotherapist and occupational therapist. The aim of the sessions is to provide people with the information and tools to help them manage their condition effectively. Patients will also have the chance to meet other people with the same condition and share their experiences.

NOS Representatives

The Bristol branch of the National Osteoporosis Society attend all our outpatient clinics where they support our patients by helping them complete fracture risk assessment forms, provide them with additional information they may require and lend a sympathetic ear to newly diagnosed patients. A significant proportion of our patients go on to join this active patient support society.

Falls and Fracture Liaison Service

The falls and fracture liaison service is a partnership between the care of the elderly team and the rheumatology unit.  The aim is to significantly reduce the risk of patients with fragile bones who have had a low trauma fracture having another.

The Fracture Liaison Service (FLS) is led by Dr Emma-Kate Reid and Dr Rachel Bradley. The FLS nurse specialist is Mrs Cathy Churchman. The rheumatology unit provides DXA scans and clinical advice where required. The FLS model has been shown to reduce re-fracture rate. Cathy Churchman can be contacted on …………

Childhood Osteoporosis

Dr Christine Burren is a paediatric endocrinologist with a special interest in osteoporosis in childhood. She leads a regional service for patients with complex or severe osteogenesis imperfecta (OI). In addition, Dr Burren takes consultant to consultant referrals for children with, or suspected to have osteoporosis. Dr Burren is at Bristol Royal Children's Hospital Paul O'Gorman Building, Upper Maudlin St, Bristol, BS2 8BJ, Fax: 0117 342 0186.

The rheumatology unit carries out scans in children which are reported by Dr Burren. Patients that have attended the regional OI service transition to follow up in the adult osteoporosis clinic with Dr Clarke

How To Access Our Services

We accept local and regional referrals from both primary and secondary care for adults considered to be at increased fracture risk.

GPs, consultants or specialist healthcare professionals may refer patients to the osteoporosis clinic (suitable for complex cases, or for patients who are at high fracture risk and unable to tolerate first line oral therapies - a scan will not normally be carried out within 2 years of any prior measurement) either in writing or via Choose and Book. A letter should be sent providing relevant details to Dr Shane Clarke, consultant rheumatologist.

GPs wishing to access the Direct Access DXA scanning service should complete a request form (Click here) and send it to DADS@UHB.nhs.uk or Dr Shane Clarke Rheumatology Unit, Old Courtyard Lower Maudlin Street, University Hospitals Bristol, BS2 8HW or Fax: 0117 342 3841

Useful links

National Osteoporosis Society

Healthtalkonline

Vitamin D: Deficiency and Guidance

What exercises can I do to help my bones?

Bristol North Somerset South Gloucestershire (BNSSG) Guidance and Shared Care Protocols

Calcium Calculator