Visit our eLearning platform this month and find out the latest on osteoporosis. Here, we speak to Dr Rizwan Rajak, consultant rheumatologist and lead for the bone health service at Croydon Health Services NHS Trust. Dr Rajak is also part of our Education Committee.
How did you get involved in osteoporosis?
I spent time at the University Hospital of Wales in Cardiff and Royal Glamorgan Hospital during my specialty trainee training, where I was able to gain exposure to osteoporosis, metabolic bone disorders, reporting on the DEXA service and all kinds of specialised treatment.
After training I spent a year in Bath working with the osteoporosis lead there, and it consolidated everything I'd done in my training. When I moved to Croydon there was no osteoporosis clinic, so I saw an opportunity to develop a service there.
How did you go about setting up the osteoporosis service?
At the time there was one fracture liaison nurse. We got talking and we decided to collaborate and see how we could build a service. The first thing we did was reach out to all the people we thought would be relevant stakeholders, including geriatrics, radiology, endocrinology, pharmacy and our own specialties; it kind of grew from there to a fully integrated service.
We aimed to create a seamless service with a clear referral pathway, working collaboratively across specialties.
You involved peer review in the process, tell us more?
When setting up the service, we asked the then National Osteoporosis Society to undertake a peer review with a view to using that to develop a business case. They came in, met the whole team, went to all the facilities, and came out with a helpful and comprehensive report.
We used the findings to develop a multi-system business case. We expanded consultant capacity to three of us seeing osteoporosis patients and the fracture liaison nursing team from one to four.
What are your top tips for someone setting up their own service?
If you're setting it up from scratch, you need to identify and work together with all the people involved in the care of osteoporosis. If you try to set it up as a rheumatology service alone, it just doesn't work as smoothly. People don't know you exist or what services you provide.
It’s also important to run regular GP and patient education sessions. Every year we run a postgraduate teaching session for GPs which helps grow knowledge about the service and ensures they’re referring people accordingly or emailing us about cases.
For those coming into existing services, it’s helpful to recognise where the gaps are. By getting a peer review, it’ll give you a thorough and independent view of the service.
How do you manage drug counselling?
One of the ways we've tried to help primary care is to develop patient leaflets which we have made available to all GP practices. Anyone who's started on oral bisphosphonates gets a leaflet which explains how to take it plus the pitfalls. It details what things to look out for, such as ensuring there's a gap left between taking calcium/vitamin D and bisphosphonate on that day. It works well and is easy to follow.
You sit on our Education Committee – how are you finding it?
I’ve always had an interest in education and I’m the course director for rheumatology for the University of South Wales. I thought it would be beneficial to be involved on a national level, which is why I decided to apply and join BSR’s Education Committee. It’s been refreshing to see such openness to innovate, coming up with new ideas and getting them put into action.
Many thanks to Dr Rajak for sharing his osteoporosis expertise. All members can access the eLearning platform as a member benefit. Log on this month to benefit from resources helping improve your knowledge and skills on osteoporosis.