Utilisation Of FRAX Tool For Primary Prevention Of Fragility Fracture In Older Person Assessment Unit At Morriston Hospital

Introduction

Osteoporosis poses a significant health challenge in older adults, especially due to fragility fractures that increase morbidity and mortality. The FRAX tool, designed to estimate a 10-year risk of major osteoporotic and hip fractures, is a key resource for guiding treatment decisions. This audit evaluated how effectively FRAX scoring and primary prevention strategies were being used in a Front Door Frailty ward.

Methods: Two retrospective audit cycles were conducted. The first included 51 patients (May–August 2024), and the second 50 patients (January–April 2025), admitted with falls. Data collected included age, sex, Clinical Frailty Score (CFS), fall/fracture history, FRAX score completion, and osteoporosis treatment status.

Results: In the first cycle, patients averaged 82.8 years old, with 60.78% female and a mean CFS of 5.43. Prior fractures were noted in 19.61%, and 35.29% had previous falls. Only 27.45% received osteoporosis treatment, and FRAX scoring was rarely used.

The re-audit showed a mean age of 83, with equal gender distribution. Fall history rose to 82%, and fracture history to 42%. FRAX scores were recorded in just 30% of cases. Among high-risk patients, 53.13% received treatment, while 46.88% did not. Treatments included bisphosphonates (35%), vitamin D alone (30%), and calcium/vitamin D combinations (35%).

Conclusion: Despite a high prevalence of falls and fractures, FRAX scoring remained underutilized. Although treatment rates improved slightly (from 27.45% to 40.82%),nearly half of high-risk patients were still untreated. The findings highlight the need for better education, standardized protocols, and integration of FRAX into routine assessments. Barriers to FRAX implementation and treatment initiation, particularly in frail populations, require urgent addressing through education, protocol development, and integration of FRAX into admission assessments. Strengthening communication with primary care and adopting a multidisciplinary approach are essential to improve primary fracture prevention in frail older adults.