Orthogeriatrics: Improving the use of Bisphosphonates

Orthogeriatrics: Improving Assessments and the use of Bisphosphonates

Introduction

At Doncaster Royal Infirmary we targeted an improvement in the care of patients admitted with a hip fracture. The first objective was to deliver more consistent Orthogeriatric Assessments. The second objective was to improve bone health assessments and the use of bisphosphonates for secondary prevention of fragility fractures.

Method

After a period of limited Orthogeriatric service, from January 2025, new medical support was provided in the form of 12 hours per week of Consultant time and support from a recently recruited Specialty Doctor. This supported the existing Specialist Nurse and Pharmacist.

We introduced a bespoke electronic proforma for Orthogeriatric Assessments and aimed to see all new patients over age 60 yrs admitted with a fractured hip within 72 hours of admission. As part of this process we aimed to improve the use of bisphosphonates for secondary prevention of fragility fractures.

Results

Objective 1 - Orthogeriatric Assessment

The number of Orthogeriatric Assessments completed within 72 hours improved from 0% in December 2024 to 11.5% (January 2025), 18.9% (February), 41.4% (March), 77.6% (April) and 85.7% (May).

Objective 2 - Bisphosphonates

The percentage number of patients started on bisphosphonate treatment increased from 13.1% (December 2024) to 16.9% (January 2025), 43.5% (February), 46.3% (March), 66.1% (April) and 59.5% (May).

Conclusion

More patients admitted to Doncaster Royal Infirmary with a hip fracture now receive an Orthogeriatric Assessment within 72 hours. This has resulted in a significant increase in the number of patients started on bisphosphonate treatment for secondary prevention.

There are common clinical concerns that can limit the use of bisphosphonates. Some of these can be overcome with the latest evidence based medicine and balancing risks and benefits.1