Musculoskeletal Network

ACI Osteoporotic Refracture Prevention Model of Care

The ACI Osteoporotic Refracture Prevention Model of Care was finalised and published in January 2011

Co-Chairs: John Eisman and Lyn March

Network Manager: Robyn Speerin

Musculoskeletal conditions are a group of chronic diseases that include arthritis and osteoporosis.  Arthritis (including osteoarthritis, rheumatoid and juvenile idiopathic arthritis) is characterised by joint inflammation and degeneration of skeletal joints.  This leads to pain, stiffness, disability and deformity of the affected joint. In Osteoporosis, lower bone density results in decreased bone strength and bone fractures from minimal trauma.  This also leads to pain, deformity, disability and premature mortality. 

In 2002 musculoskeletal conditions were identified by the Commonwealth Government of Australia as one of the seven National Health Priority Areas in recognition of the major health and economic burden these conditions place on our community. The seven National Health Priorities form a part of the National Chronic Disease Strategy 2005, each of which have a specific National Service Improvement Framework – see Resources for the specific musculoskeletal document location.

Morbidity from overall musculoskeletal disorders is thought to affect over 30% of the Australian population. It is estimated that over 6 million Australians suffer from a musculoskeletal condition with arthritis accounting for over 3 million of these people.  Osteoporosis is reported to affect over 586,000 Australians but this is recognised to be an underestimate, as osteoporosis is not reported or diagnosed in many of those affected.  The Australian Institute of Health & Welfare reports these conditions accounted for $4 billion, or 7.5% of health system expenditure in 2004-05.

Australian data have revealed a clear correlation between minimal trauma fracture and mortality.  When mortality rates of healthy people aged 60 years or more are tracked, it can be found that in women the rate increases from 4.3 to 7.8 per 100-person years for those who have had minimal trauma fractures, and in men it increases from 5.5 to 11.3 per 100-person years. 

In a concerted effort to address this National Health Priority Area in NSW, the NSW Agency for Clinical Innovation (ACI) Musculoskeletal Network was convened in early 2009 as the peak body advising the NSW Department of Health on how best to improve services for the people of NSW with these debilitating disorders. The ACI Musculoskeletal Network is made up of the membership of the former NSW Chronic Care Program Musculoskeletal Clinical Expert Reference Group and the GMCT Orthopaedic Network. 

The Network aims to:

• Build an active and viable Musculoskeletal Network that includes multidisciplinary clinicians from both the public and private health sectors, the Clinical Excellence Commission, NSW Department of Health, medical, nursing and allied health educational institutions, consumers and relevant peak bodies such as Arthritis NSW and Osteoporosis Australia.
• Improve equity of access to musculoskeletal services so that all residents of NSW who have these disorders will have opportunities that lead to better health and quality of life.
• Develop and promote appropriate models of care that include proven interventions and are suitable for implementation in a variety of population groups and settings.

Following consultation with multidisciplinary clinicians, consumers, and representatives from peak clinical groups such as the Clinical Excellence Commission, the key issues being addressed by the Musculoskeletal Network are:

• Osteoporotic re-fracture prevention
• Timely access to joint replacement
• Development of a guideline for the pre, peri and post operative care of people requiring elective hip and knee joint replacement surgery
• Early intervention in Juvenile Idiopathic Arthritis and other Paediatric Rheumatoid Disease
• Development and implementation of a model of care for the conservative treatment of people with osteoarthritis
• Curriculum development on Osteoporosis for Junior Doctors - in collaboration with IMET
• Considerations concerning the availability of a musculoskeletal nurse education program.

Later work will address early access to appropriate care for adults with rheumatoid arthritis, and improved management of back pain.