Overview
The Metabolic Bone Unit provides expert advice, investigation and treatment for patients with osteoporosis (fragile bones) and other metabolic bone diseases such as Paget’s Disease and Osteogenesis Imperfecta, as well as rarer bone diseases. The unit also provides metabolic bone advice to specialties across the Trust, as well as answering primary care queries regarding bone health.
The unit is based in the Musculoskeletal Outpatient Department at Freeman Hospital and holds a range of specialist clinics.
The Metabolic Bone is consultant led and supported by a team of Osteoporosis Specialist Nurses, a pharmacist as well as other doctors and a physiotherapist with expertise in metabolic bone disease.
Rapid diagnosis
When appropriate, a Dual Energy X-ray Absorptiometry (DXA) scan is offered to diagnose osteoporosis and assess future fracture risk. DXA scan results, together with information on clinical risk factors and other relevant medical issues, can help to identify whether or not patients would benefit from preventative treatment.
The Metabolic Bone Unit sees referrals from primary care as well as a wide range of specialists within the Trust. A fracture liaison service (FLS) and Orthogeriatrics’ team also facilitates care of patients admitted to hospital with a fracture (broken bone). Patients identified by these teams may also be seen in the metabolic bone clinic for ongoing management decisions. The aim is to reduce the risk of fractures within this patient population.
Treatment
Some bone treatments consist of medication that can be taken in the community with reviews and investigations (such as blood tests or scans) at the hospital when necessary. Some treatments (such as zoledronate infusions which occur via a drip) however need to be given in hospital and this is done on the rheumatology day case unit. The day case unit is primarily staffed by nurses and nurse practitioners who are experienced in administering bone sparing treatments such as zoledronate infusions. Patients starting denosumab treatment (an injection underneath the skin) should also receive their first injection at the day unit, before future injections can sometimes be given locally by a GP surgery, unless there are complications such as reduced kidney function when patients will need to attend the day case unit more frequently for blood tests and injections.
Bone sparing treatment courses are usually for several years. As such patients with metabolic bone disease do not need to be seen as frequently as other rheumatology patients. They should have a clinic review following completion of a treatment course, or every 3 years if on life-long treatment – or more frequently if new issues arise.
Research and Excellence
Our professional staff are involved in a variety of research and educational initiatives. This means patients can be offered the opportunity try potential new therapies for their condition and are often first to benefit from ground-breaking new treatments. The metabolic bone team participates in a number of local and regional multidisciplinary team meetings (MDTs) in order to provide the best care for patients.
The Freeman Hospital is a Paget’s Disease Centre of Excellence. There is also a combined clinic with the Clinical Genetics Team for patients with rarer bone conditions.
