Case study: pharmacist-led clinical pathway, Belgium

A pharmacist-led clinical pathway was implemented to ensure people with fragility fractures received appropriate testing and treatment.

Case study: pharmacist-led clinical pathway, Belgium

What does the programme involve?

A pharmacist at AZ Sint-Jan hospital in Bruges, Belgium, initiated and led a clinical pathway for fragility fractures to standardise care.1 The pathway was developed in collaboration with a multidisciplinary team. It required that all people admitted to the orthopaedic ward with a fragility fracture be tested for osteoporosis and receive treatment where appropriate. The pharmacist also gave advice on medications and followed up with patients.

A range of other clinical pathways are already in place at AZ Sint-Jan hospital.2 As part of the Clinical Pathways Network, the hospital has set a goal of developing dedicated clinical pathways for 60% of its patients.2

What has the programme achieved?

Introduction of the clinical pathway has led to a number of improvements:1

  • In-hospital management of fragility fractures improved significantly after the pathway was implemented.
  • The number of dual energy X-ray absorptiometry (DXA) scans conducted has risen, leading to an increase in osteoporosis diagnoses.
  • The number of people referred to a specialist (orthopaedics, geriatrics or rheumatology) and the number of prescriptions of appropriate osteoporosis medications have increased.

What lessons can be learnt from this programme?

Implementation of a dedicated pathway can significantly improve in-hospital care for people with fragility fractures. It can ensure that fragility fractures are managed consistently by all specialists, and that people receive investigation and appropriate treatment for osteoporosis.

Pharmacists may be well positioned to identify gaps in care and initiate improvements. In some contexts, they may also be able to oversee the delivery of care improvement initiatives.


The information in this case study is based on research conducted for the 2020 publication Osteoporosis and fragility fractures: a policy toolkit.
Date of preparation: October 2020.
References +
  1. Saey S, Piette Y, Verstraete B, et al. 2018. Building for better bones: evaluation of a clinical pathway in the secondary prevention of osteoporotic fractures. Eur J Hosp Pharm 25(4): 210-13
  2. AZ Sint-Jan. Klinische paden. [Updated 16/03/17]. Available from: [Accessed 01/09/20]
  3. Netwerk Klinische Paden. Welkom op de website van het Netwerk Klinische Paden. Available from: [Accessed 01/09/20]