My Working Day: Mary Langan, clinical nurse specialist in osteoporosis at Merlin Park hospital, Galway, on why she loves her job
My role as a clinical nurse specialist is to target people over 50 who present to the fracture clinic at Merlin Park. We call it the secondary prevention of osteoporotic fracture service, or the "Spoof" service for short!
The service has been up and running since only July 2005. I have seen more than 400 patients in that time.
After attending at A&E in Galway or Roscommon, patients come to the fracture clinic at Merlin Park. On their first day, I meet them, introduce the subject of osteoporosis and arrange to meet them at their next appointment at the clinic.
I target people who have sustained a fracture from a low-impact fall - these are falls from a standing height as opposed to falls from a height. Usually, I see people over 50; however, doctors can refer younger patients who have unexplained fractures or other predisposing factors such as someone who has been on steroids long term.
The next time I meet the patient I assess risk factors such as family history and lifestyle. Exercise and diet, especially calcium and vitamin D intake, are important for assessing the risk of osteoporosis. The recommended daily allowance of calcium is 1,200 milligrams, which is three portions of dairy products a day (a 200ml glass of milk, a square inch of cheese and a pot of yoghurt, for example). Some 800 micrograms of vitamin D is also important - this is 15 minutes of sunshine a day or eating omega-three foods.
I then book the patient in for a bone density scan. I will get the results for this in four to six weeks. By bypassing the GP waiting list for scans, this is considerably faster than normal.
Once the results are in, I sit down with consultant rheumatologist Dr Robert Coughlan and a treatment for the patient is decided upon.
Some patients will only need a follow-up scan in five years, others may need to commence vitamin D and calcium supplements and some may need to start taking an osteoporosis-specific drug.
The patient may be referred to other services such as a dietician or gastroenterologist if their osteoporosis is a result of Crohn's disease. If someone has very severe osteoporosis, they will be called for an assessment at the osteoporosis clinic. They may need to go on a short-term treatment of daily injections of parathyroid hormones, which build up the bone.
I will keep in contact with the patient's GP, the consultant, the orthopaedic surgeon and the patient. The new service takes the onus off the orthopaedic teams to follow through on what is essentially a medical condition.
The patient is handed over to the GP with recommendations for treatment. Under the old system patients often slipped through the net. After a fracture they didn't necessarily go back to their GP and then didn't get assessed for osteoporosis. Even if they did, they sometimes waited from six months to one year for the scan.
I do a lot of health promotion work. Fall prevention is hugely important in osteoporosis care and hopefully in the future this aspect of the service will be developed.
Osteoporosis is a silent bone disease and a fracture may be the first clue that a person has developed brittle bones. Women are more at risk of dying from an osteoporosis event than from breast cancer. A hip fracture has a 20 per cent mortality rate and 50 per cent of victims will not be able to return to their previous state of mobility.
Before this, I had worked as an orthopaedic theatre nurse for more than 20 years. My familiarity with the orthopaedic teams helps in this position. I really enjoy the personal contact with patients and love the fact that I can give them individual attention.
(In conversation with Fiona Tyrrell)