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BMJ Open. 2019 Jul 29;9(7):e027013. doi: 10.1136/bmjopen-2018-027013.

Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre-post study.

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Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia.
Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Victoria, Australia.
Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia.
Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia.



Traditionally, the approach to fracture prevention has focused on increasing bone mineral density while typically lacking a combined clinical approach to falls prevention and vice versa. To resolve this gap, we implemented and evaluated a novel combined model of care to the assessment and prevention of osteoporosis and falls in the outpatients setting.


Falls and Fractures Clinic (FFC) at Nepean Hospital (Penrith, NSW, Australia).


Pre-effects and posteffects assessment of 106 community-dwelling older patients referred from the community.


Previous falls and fractures were recorded. Clinical, functional and paraclinical evaluations were performed. A comprehensive multidisciplinary care plan was then tailored based on the presence of risk factors. Six-month follow-ups were performed assessing the incidence of falls and fractures, change in risk factors for falls and level of risk, with the recommended plan.


We report that 97% of patients had a fall in the preceding 6 months, 47.6% of whom experienced a fracture from the fall. Furthermore, 64% of patients had a marked risk for falling by Physiological Profile Assessment (PPA), 90% had intermediate-high 10-year probability of fracture according to FRAX and 78% had sarcopenia. At 6-month follow-up, we observed more than an 80% reduction in falls and recurrent falls, and 50% reduction in fractures. In addition, 65% of patients had reduced PPA and a 57% reduction in 10-year fracture probability.


In conclusion, we suggest that a multidisciplinary FFC can provide substantial reductions in falls and fractures for high-risk older people, even over a relatively short 6-month time period. The current model of service provision via traditional falls clinics could be significantly improved by encompassing fracture prevention within the multifactorial approach to interventions.


falls; falls and fractures clinic; fractures; osteoporosis; osteosarcopenia

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