Compliance with the GIRFT Vertebral Fragility Fracture Pathway: A Clinical Audit in a District General Hospital

Introduction:
Vertebral fragility fractures (VFFs) are the most common osteoporotic fracture and are often under-recognized, leading to significant morbidity, mortality, and healthcare costs. Despite evidence-based guidance, including the GIRFT VFF Pathway, variation in assessment and management persists. This audit assessed compliance with the GIRFT pathway in various departments of a district general hospital to identify gaps in care and areas for improvement.

Methods:
A retrospective case note review was conducted of adult inpatients with suspected vertebral fragility fractures between 01/09/2024 and 28/02/2026. Patients were identified via ICD coding and electronic records, with manual review of imaging and notes to confirm eligibility. Only radiologically confirmed non-traumatic vertebral fragility fractures were included. Data was extracted using a standardised GIRFT-based proforma covering assessment, imaging, analgesia, investigations, bone health, multidisciplinary input, and discharge planning. A total of 25 patients were included.

Results:
Compliance was partial, with 15/21 standards at least partially met (3 fully compliant, 12 partially compliant, 6 not met). VTE assessment (96%), discharge documentation (96%) and avoidance of bracing (100%) demonstrated strong adherence to key pathway standards. Lower compliance was seen for formal frailty assessment, functional pain scoring, investigation bundles, and documentation of delirium and nutrition assessments. Bone health review was documented in 56% of patients and follow-up arrangements in 24%. No eligible patients underwent MRI STIR imaging.

Conclusions:
Compliance with the GIRFT VFF pathway was variable. Review of individual cases suggested that apparent non-compliance often reflected appropriate clinical judgement rather than omission of care, particularly in patients receiving palliative care, living with severe frailty, or unlikely to benefit from further investigation, treatment, or follow-up. Opportunities for improvement relate primarily to more consistent documentation of clinical reasoning and consideration of pathway recommendations where deviation is clinically appropriate.