Improving nurse-led bone health assessment in a Multidisciplinary Parkinson’s Clinic

Introduction
Parkinson’s disease increases fracture risk due to higher fall rates and increased osteoporosis prevalence. This two-cycle bone health audit assessed adherence to the BONE-PARK algorithm at Florence Nightingale Community Hospital’s Parkinson’s clinic and evaluated improvements over 12 months.

Methods
Fifty patient records were reviewed to assess bone health management, focusing on fracture risk assessments (FRAX/QFracture), serum calcium, vitamin D, and follow-up actions, establishing a baseline before intervention. A re-audit of 39 patients after 12 months assessed progress following Cycle 1 recommendations. The Chi-squared test evaluated statistical significance between cycles.

Results
In Cycle 1, 21/50 (42%) had vitamin D levels checked, 1/38 (3%) of those not on calcium supplements were asked about dietary calcium, and 15/50 (30%) had a FRAX assessment within the previous 12 months. QFracture was not used. Recommendations included post-clinic telephone fracture risk assessments if not completed during the clinic, routine vitamin D testing, and QFracture use where appropriate.

Cycle 2 reviewed patients seen while changes were still being introduced. Vitamin D testing improved to 27/39 (69%, p<0.02), and FRAX assessments to 23/39 (59%, p<0.01). Dietary calcium intake was not assessed in any patient, and QFracture was performed in only 11% of indicated cases.

Conclusion
Cycle 1 recommendations generated improvements in bone health assessment and management, but cycle 2 highlighted that further work is needed to consistently align with national guidelines. Bone health documentation will include questions on calcium intake and exercise. The clinic letter template will be updated to advise on calcium-rich foods and weight-bearing exercise.