The Royal College of Chiropractors’ Health Policy Unit is pleased to announce the publication of a new quality standard which covers the chiropractic assessment and management of patients with osteoporosis and those at risk of osteoporotic fracture.
This quality standard is specific to the environment in which chiropractic care is provided; a setting that is often less constrained by time and resource limitations than other healthcare settings, and where the physical nature of some therapeutic interventions means that understanding a patient’s bone health is of particular importance. Patients present to chiropractors with a wide range of different complaints and (whether or not related to their presenting condition) the presence of osteoporosis, an osteoporotic fracture or major risk factors of osteoporosis should be a consideration.
Chiropractors have the skills and competencies to identify those patients with significant risk factors prior to the potential deterioration in bone density, and to provide early preventative support and advice. Fractures due to osteoporosis are a significant and growing public health concern and chiropractors are well-placed to identify those at risk, support them to make the necessary lifestyle and practical changes to help limit that risk, and to make appropriate referrals for further investigations and management. This embraces best practice in relation to the public health responsibilities of primary healthcare practitioners.
Vertebral fractures are the most common osteoporotic fracture although up to 70% do not come to medical attention and thus remain undiagnosed. Patients with these fractures often present to chiropractors with an increased kyphosis, loss of height and back pain. Given that vertebral fractures are a powerful predictor of further fracture, chiropractors have an important role to play in identifying and managing these patients, including making appropriate referrals, in an attempt to reduce the risk of further fractures.
Due to the prevalence of osteoporosis, increasing numbers of patients that present to chiropractors have already been diagnosed and are taking medications for the condition. Depending on the circumstances, chiropractors may have a multi-disciplinary role to play in co-managing these patients by providing conservative, non-pharmacological care, as well as communicating with the patient’s GP or other healthcare professionals.
Many different patient presentations are associated with osteoporosis, from those who simply have a number of positive risk factors to patients in severe pain having suffered a recent fracture, and the exact management will be different in each case. Therefore, the quality statements that make up the new quality standard are general but, nevertheless, provide achievable markers of high-quality, cost-effective patient care.
The RCC’s Chiropractic Quality Standard for Osteoporosis is available for download here in full and abbreviated versions. A separate copy of the Osteoporosis Assessment and Management Flowchart, which forms part of the full version of the document, is available on the same webpage.