Bone Health Assessment in Older Adults Admitted with Falls: A Clinical Audit from a UK Geriatric Service

Introduction

Older adults admitted with falls are at high risk of osteoporosis and fragility fractures. National guidance (NICE CG146 and NOGG recommendations) recommends fracture risk assessment (e.g. FRAX) and bone health protection plans. This audit aimed to evaluate adherence to guideline-recommended assessment and management of bone health in older adults admitted with falls and no acute fractures.

Method

A retrospective audit was conducted across five geriatric wards in a UK district general hospital. Patients aged ≥65 years admitted with falls and no acute fractures were included. Data were collected between November 2025 and January 2026 using electronic patient records. Objectives included FRAX score calculation, Vitamin D and calcium testing, FRAX risk stratification, and evidence of subsequent intervention. Data were anonymised and analysed.

Results

The first audit cycle included 57 patients (31 female, 26 male), while the re-audit included 55 patients (35 female, 20 male). Mean age was 85 years in both cycles. FRAX score calculation increased from 10.5% in the first cycle to 40.0% following intervention. In the re-audit, 5 patients (22.7%) were classified as low risk, 9 (40.9%) as intermediate risk, and 8 (36.4%) as high risk. Management following FRAX risk stratification improved across all risk categories: lifestyle advice was documented in 100% of low-risk patients, DEXA scan arrangements in 77.8% of intermediate-risk patients, and osteoporosis treatment initiated in 50.0% of high-risk patients. Vitamin D testing increased from 71.9% to 76.4%, while calcium testing increased from 86.0% to 89.1%. Documentation of Vitamin D results improved from 28.1% to 34.5%, although overall documentation remained suboptimal.

Conclusion(s)

This audit demonstrated substantial improvements in osteoporosis risk assessment and bone health management following targeted educational interventions. FRAX score utilisation increased significantly, with corresponding improvements in risk-based management, including DEXA scan arrangements and initiation of osteoporosis treatment. While Vitamin D and calcium testing remained consistently high, documentation of investigations and management plans continues to require improvement. Simple educational measures were associated with improved adherence to local and national bone health guidelines and may help reduce future fracture risk in this high-risk population.