Bone health assessment in outpatient clinic for older people who have a history of falls: A Quality Improvement Project
Abstract
Introduction
Fragility fractures cause pain, mobility problems and negatively impact on people’s quality of life. Hip fractures have a high mortality rate, with 20% of people dying within 1 year after surgery. Falls increase the risk of fragility fractures. NICE and the National Osteoporosis Group Guidelines recommend a bone health assessment be undertaken in people with a history of falls. The FRAX tool is an easy to use tool to predict osteoporosis risk and guide treatment.
Our quality improvement project aimed to improve the number of people having an assessment their bone health when presenting to our clinics with a history of falls.
Method
We undertook a retrospective review of the clinic letters for new patients presenting to our clinic with a history of falls from January to April 2024.
We subsequently created a paper questionnaire incorporating baseline FRAX questions which were given to people attending clinic as a new appointment, to complete whilst in the waiting room. We then undertook a retrospective review of clinic letters for those seen in clinic during this intervention period (March to April 2025). People already on bone protection were excluded from both groups.
Results
Pre-intervention (n=73) 2.7% of people had a FRAX score calculated, 3.8% had a DEXA requested and 12% had bone protection discussed. Post-intervention (n=24) 71% of people had a FRAX score documented, 25% had a DEXA requested and bone protection was discussed with 62% of people. In both groups only 4% of people had bone protection commenced during that appointment (Alendronic acid), despite 29% of the post-intervention group having high risk FRAX scores.
Conclusion
Questionnaires were effective in encouraging clinicians to undertake a bone health assessment in people presenting to clinic with a history of falls. Despite this, few people were started on pharmacological treatment when first seen in clinic.