Abstract
Introduction
Bone health declines with age, with almost 3 million people in the UK living with osteoporosis. Osteoporosis is a common condition affecting older people where bone density is reduced, increasing the risk of fragility fractures. Most patients are diagnosed following a fracture, and only then prescribed bone protection. Older people have an increased falls risk due to muscle weakness, impaired vision and balance, pain, postural hypotension and medications; increased falls frequency correlates to increased fracture incidence. We aimed to evaluate whether bone health was routinely assessed on hospital admission in a group of older people, and consider interventions to improve screening and reduce fracture risk.
Method
28 patients (aged 70-102) were assessed on admission to the Older Person’s Acute Medical Unit (OPAMU) at a large teaching hospital. We recorded whether the comprehensive geriatric assessment (CGA) bone health section was completed, documented reason for admission and used FRAX to predict 10-year osteoporotic fracture risk. We used the hospital digital database to access medical history, including previous fractures and medications. Data was inputted into a proforma and analysed using Microsoft Excel.
Results
There was a high incidence of patients admitted following a fall (16/28 (42%)). Despite this only 9 of 28 (32%) patients had a bone health assessment completed. Subsequent FRAX screening identified 15 of 28 (54%) patients to be classed as 'high' or 'very high' risk, 8 of whom had a previous diagnosis of osteoporosis, and 2 of whom were identified as requiring new bisphosphonate prescription.
Conclusions
Bone health assessments are not routinely carried out in OPAMU, despite a large proportion of patients being at risk of osteoporosis and fractures. Interventions to improve this include:
- Ward-round reminders to complete bone health assessments
- Bringing the CGA to the bedside as a prompt
- Educating staff about the importance of bone health screening