Abstract
Introduction
Osteoporosis is systematic skeletal disorder causing low bone mass, which increases pre-disposition to fractures. In older adults, fragility fractures are usually the first presentation of this. National Osteoporosis Guidelines Group (NOGG) have published evidenced-based guidelines for identifying and managing bone health in the over 50’s, however compliance can be variable.
Methods
An EMIS search was conducted of patients at the Surrey practice which identified 46 patients over 50 years old (25 of which were over 70 years old) who had been coded as having had a fragility fracture. Their records were reviewed to ascertain the type of fracture they had, if a DEXA scan had been done and any bone protective medication reviewed. Their FRAX score was calculated to determine what treatment category they fall into; these included lifestyle advice only, measuring bone mineral density with a DEXA alongside lifestyle advice or initiating bone protective medications without need for a DEXA.
Results
Of the 46 older adults identified only 7 were compliant with NOGG guidance. 6 patients (all over 70) were identified to be at the treatment threshold for initiating bisphosphonates but had not been prescribed these. 27 were identified to be needing a DEXA scan (and treatment if indicated). 6 patients needed to be given lifestyle advice and started on vitamin D.
Conclusions
Adherence to the NOGG guidelines was suboptimal and highlighted the under-recognition and under treatment of osteoporosis in primary care. Patients who require further management have been contacted offering lifestyle advice and have been given the opportunity to be referred for a DEXA scan. Those requiring bisphosphonate therapy will have a telephone consultation scheduled to counsel them regarding this. The practice plans to highlight discharge letters from all over 50’s with fractures to the clinical pharmacy team for FRAX scoring to optimise future bone health management.
Comments
Really useful audit showing…
Really useful audit showing an evident gap in bone protection services in the GP. Good idea to have them flagged up from the discharge letters so they can be identified. Wondering if it's worth screening patients yearly over a certain age (not just those with fragility fractures) to identify them early, although it will be alot of work hence might not be feasible!