Bone Protection Treatment Trends from NHFD Data at Wrightington, Wigan and Leigh NHS Teaching Trust - Four Year Analysis

Introduction:

Current national and international guidelines recommend intravenous zoledronic acid as first line choice post hip fracture. The aim of this work was to analyse treatment choices made by orthogeriatric team over the last four years and assess opportunities for improvement in the pathway.

Method:

Data was collected retrospectively, using NHFD dataset for Royal Albert Edward Infirmary over 4 year period (2022 – 2025). Details of treatment choice were analysed across the 4 years with particular focus on timeline from admission to hospital to first dose of intravenous zoledronic acid being administered.

Results:

There were a total of 420 in 2022, 432 in 2023, 381 in 2024 and 470 in 2025 patients who were entered on the NHFD locally. In 2022, 192 patients (45%) of patients were discharged on oral bisphosphonate, whereas this number went down to 174 (40%) in 2023, 22 in 2024 (6%) and only 14 (3%) in 2025. Meanwhile, use of zoledronic acid increased more than five fold from 56 (13%) in 2022 to 295 (63%) in 2025. Overall 393 patients or 84% of our cohort were discharged home with injectable therapy planned. As we standardised the practice of giving first dose of bone protection during initial hospital admission, average time from admission to first dose of intravenous zoledronic acid being given has reduced from 106 days in 2022 to 9.5 days in 2025.

Conclusions:

By working together with trauma coordinators, orthopaedic , pharmacy and orthogeriatric teams, we have successfully changed practice to address patients’ imminent risk of re-fracture after initial admission. Current waiting times for intravenous zoledronic acid remain challenging in outpatient setting due to significant increase in demand without reciprocal redesign of service provision. Further work analysing possibility of homecare provision for all injectable therapies will be completed aiming to address this mismatch.