Abstract
Introduction:
Fragility fractures can have a profound impact on older adults’ quality of life. Optimising bone health by checking vitamin D level, FRAX score, and actioning outcomes provides a cost-effective strategy for reducing the incidence of these fractures.
Our aim therefore is to promote awareness and undertaking of bone health assessments in the Older Persons Unit (OPU)
Methods:
This was a pre-post cross-sectional study. Data was collected from 212 patient records over two separate days, one month apart. Patients admitted to the OPU at St Thomas’ Hospital were included and data was obtained from patient records using EPIC.
Three strategies were implemented to improve awareness, accessibility, and time efficiency:
- Posters with QR codes linking relevant resources and the FRAX tool were placed throughout the OPU.
- An email campaign targeted both junior and senior staff to raise awareness.
- A shared Epic ‘SmartPhrase’ which auto-populated relevant results and provided an easy-to-follow template for documenting FRAX scores and outcomes.
Results:
In the first data collection, FRAX documentation was recorded for 13 out of 106 patients, compared to 22 out of 106 in the second cycle (p = 0.096). Notably, vitamin D assessment and management showed significant improvement: 80 patients had their vitamin D level checked in the second cycle compared to 63 in the first (p = 0.013). Treatment of vitamin D insufficiency (<25 nmol/L) also improved from 7 of 16 patients to 12 of 14 patients (p = 0.017).
Conclusion:
There has been a positive shift in how bone health is addressed in older patients. Most notably, vitamin D testing and treatment significantly improved. While FRAX documentation showed modest gains, the increased focus on vitamin D reflects growing awareness of bone health. This is an encouraging trend, but further engagement is required to consolidate and sustain these improvements.
Comments
Very interesting…
Very interesting interventions. I know a little out of the scope of poster, but out of curiosity did you notice that patients who did have FRAX calculated also had a new or recent diagnosis of fracture or was there another risk factor which may have increased the chance they had a FRAX? (Appreciating all patients should have a score calculated!)
I completely agree, every…
I completely agree, every patient on an OPU should have a FRAX score, and that’s a great question! While we didn’t specifically collect data on this, it may have influenced the results. Looking at demographics, both audit cycles had similar male-to-female ratios, lengths of stay, and ages. One factor that may have affected the results is that the patients most likely to have a FRAX score documented were probably the frailest. These patients may also have been at higher risk of prolonged hospital stays, meaning that some FRAX scores recorded in Audit 2 could have belonged to older patients from the original audit, potentially influencing our findings.
We are planning a new audit cycle in the acute frailty unit on our admission ward. This will allow us to obtain relevant history on fragility fractures at admission and address the issue of patients whose stays span both audit cycles.
Very important piece of work…
Very important piece of work and pleasing to see an improvement in documentation and actioning, particularly for vitamin D checking and correcting!
Did you see from any of the data collected why actioning FRAX regarding antiresorptive treatment did not see as much improvement as vitamin D?
Thank you
There was no specific data…
There was no specific data in these two cycles. I think it would likely be a combination of factors however which would need to be explored in a qualitative study to better understand. I would imaging the more likely causes for the differences is that Vitamin D is simple to check and treat, whereas FRAX requires more steps calculating, interpreting thresholds, and deciding between bisphosphonate treatment or DEXA. The time and cognitive load likely lead to limited improvement.
Vitamin D Assessment and Treatment Practices
Really interesting work! I’m curious — did you look at how many patients actually had vitamin D levels measured versus those who were empirically supplemented? Also, were patients being loaded with vitamin D even if there was no immediate plan to start zoledronic acid or denosumab?
We found that vitamin D…
We found that vitamin D replacement occurred even when antiresorptive therapy wasn't planned. Many patients received vitamin D purely because deficiency was identified, rather than in preparation for parenteral therapy. In terms of the empirical supplementation, there was a number of patients who had levels >50 who were on vitamin D replacement, which was either empirical from primary / OTC or had previous low Vitamin D levels who had been treated. There was a small percentage of those on vitamin D who hadn't had levels check on the admission. we didn't specifically look at this but of those on vitamin D replacement with levels higher than >50 nmol/L this was comparable in both groups at around 45% total vitamin D replaced.