Comprehensive osteoporosis management with easy access to bone mineral density measurements

The majority of people with osteoporosis are never evaluated even though effective treatments are available. The County Council of Värmland in Sweden has implemented an osteoporosis management model that has been shown to be effective in promoting awareness and providing care for osteoporosis patients. Discussions among a prevention group on osteoporosis in the county council were opened in 1997. The county of Värmland covers a large area, and the distances from the peripheral parts to the main city are approximately 300 km and cumbersome for the inhabitants. The importance of having an osteoporosis service that could reach the county inhabitants in a convenient way was therefore recognized.

Three thousand four hundred patients were evaluated between March 2001 and December 2003. Guidelines for patient selection for bone density testing and treatment guidelines were formulated. Promoting awareness was an important prerequisite for the model to function. This was accomplished by having the measurement devices where the patients showed up and by regular education of the primary care doctors.

A multidisciplinary team was established and consisted of primary care doctors, orthopaedic surgeons, internists, physiotherapists, a patient organization member, a county health care representative and nurses. Team members met every third month and agreed upon clinical guidelines for implementing the system. The presented osteoporosis management system is not a screening approach as all patients had risk factors for osteoporosis before they were suggested for bone density testing. This study shows that providing a comprehensive package of measures makes it possible to establish an effective osteoporosis management system with limited economical resources.