Case study: Multidisciplinary osteoporosis outpatient clinic, Guarda, Portugal

An osteoporosis clinic was established in 2017 with the aim of preventing future fractures. It was adapted in 2019 to implement a multidisciplinary approach.

Case study: Multidisciplinary osteoporosis outpatient clinic, Guarda, Portugal

What does the programme involve?

An osteoporosis clinic was established in Guarda following collaboration between the rheumatology and orthopaedic departments. Through the programme, nurses identified osteoporosis patients who were then seen by a rheumatologist so that appropriate therapy could be initiated to prevent future fractures.1 The clinic was initially designed to encourage orthopaedic surgeons to refer hip fracture patients, although fracture patients could also be referred from other departments.1 In 2018, the programme was amended, shifting responsibility for referral to rehabilitation nurses.2

More recently, the clinic established a multidisciplinary model. Patients seen at the clinic from October 2019 have been supported by a rheumatologist, a rehabilitation nurse and a nutritionist, whom they see at an appointment around six to nine weeks after their fracture.2

The programme also involves regular follow-up. Staff from the programme call patients one month and three months after the appointment to monitor whether they are following the advice they have received. Six-month follow-up appointments were also planned but were delayed due to the COVID-19 pandemic.2

What has the programme achieved?

The clinic has had a positive impact. Between January 2017 and May 2019, almost 100 patients were referred to the osteoporosis clinic; 77 patients attended their scheduled appointments and, of these, more than 70% had medication prescribed.3 Six-monthly follow-up seems to have supported many of these patients to remain on medication. Clinic staff noted an improvement in the appropriateness of referrals once rehabilitation nurses were responsible for referring patients.2

What lessons can be learnt from this programme?

Multidisciplinary osteoporosis clinics are a feasible model in Portugal. More than three quarters of patients referred to the clinic attended their appointment.

Inclusion of rehabilitation nurses can improve the appropriateness of referrals to a secondary fracture prevention service. This supports the delivery of a more efficient service.


The information in this case study is based on research conducted in 2020.
Date of preparation: February 2021    HB-PRO-1220-00010
References +
  1. Pinto A, Ferreira J, Vaz C. 2018. Creation of an osteoporosis outpatient clinic: report of first year experience. XI Congresso de Osteoporose; May 2018; Coimbra, Portugal
  2. Ferreira J. 2020. Interview with Taylor Morris at The Health Policy Partnership [Telephone]. 05/06/20
  3. Pinto AS, Santos FC, Matos L, et al. 2019. Consulta multidisciplinar de osteoporose: A experiência de um centro. 13º Congresso Nacional do Idoso; 27-28 June 2019; Porto