Fall? Think FRAX: A Quality Improvement Project Aimed to Improve FRAX Score Documentation on Elderly Inpatient Wards

Introduction  

Osteoporosis is an asymptomatic chronic condition, often undiagnosed until a fragility fracture occurs. It is diagnosed through bone mineral density (BMD) using DEXA scans, however risk assessment tools such as the FRAX risk score can predict absolute risk of major osteoporotic fractures. This quality improvement project aims to improve FRAX score documentation in elderly patients admitted with falls.  

Methods  

A pre-interventional retrospective analysis of patients aged ≥65 years female >75 years male with a Clinical Frailty Scale (CFS) ≥5 as per the NICE Osteoporosis - prevention of fragility fractures guidelines was conducted. The study population reviewed included patients admitted with a fall to the acute frailty admission units at Leeds Teaching Hospitals Trust.  Exclusion criteria were patients already on pharmacological management for osteoporosis.  Data was collected including basic parameters and FRAX score documentation to capture baseline practice. Initial Interventions were introduced in the form of posters and verbal informal presentations to resident doctors. Descriptive statistics were used for analysis. Ethics approval was not required as this was an audit of routinely collected clinical data.  

Results  

A total of 70 patients fit the inclusion criteria. Pre-intervention rates of documentation of FRAX scores were 5% with a decrease post intervention to 3.33%. 25% of the cohort were admitted with fractures of which only 1 patient had a FRAX score documented. In comparison, other relevant scores such as 4AT and CFS had an 84% and 85% documentation rate respectively.

Conclusion  

In conclusion, the rates of FRAX score documentation, as well as investigations related to bone health, were suboptimal in the trust. This remained so following initial intervention. Further root cause analysis and subsequent intervention is required to support early referral for DEXA scanning and prescribing of bone-sparing treatment to reduce fracture risk in patients with undiagnosed osteoporosis.