FRAX Assessment in Geriatric Inpatients Following an Inpatient Fall: A Clinical Audit

Introduction

Inpatient falls provide an opportunity to identify older people at increased risk of future fragility fractures and optimize bone health. Local practices suggested that fracture-risk assessment following inpatient falls was inconsistent. We audited compliance with NICE CG146 recommendations regarding fracture-risk assessment following inpatient falls and evaluated the impact of an educational intervention. 

Method

Two data collection phases were conducted across five geriatric medicine wards. Patients sustaining an inpatient fall were identified through the DATIX incident reporting system and electronic records reviewed. Data collected included post-falls assessment, FRAX completion, use of the trust’s post-falls template, and osteoporosis treatment initiation. Patients were excluded if they were receiving denosumab or oral bisphosphonates at admission, or if they had received intravenous bisphosphonates within the preceding year. The predefined audit standard was FRAX assessment in 80% of eligible patients. 

Following initial data collection, 15 ward-based teaching sessions (3 per ward over 1 month) and educational posters were delivered across all wards. Posters summarized initial data findings and provided QR-code access to the FRAX calculator. A post-intervention assessment was then undertaken. 

Results

40 eligible inpatient falls were identified at baseline and 39 post intervention. Post-falls assessment was documented in 35/40 (87.5%) and 35/39 (89.7%) cases respectively. FRAX assessment remained scarce, decreasing from 3/40 (7.5%) to 2/39 (5.1%). Use of the trust's post-falls template was similarly low, occurring in 7/40 (17.5%) and 5/39 (12.8%) cases respectively. 

Conclusion

A substantial gap exists between completion of post-falls clinical reviews and formal fracture-risk assessment following inpatient falls. Despite educational sessions and ward-based reminders, FRAX completion remained markedly below the predefined standard. However, where FRAX assessments were performed, they informed clinical decision-making and facilitated osteoporosis treatment. These findings suggest that fracture-risk assessment has not been successfully integrated into routine post-falls workflows. Future quality-improvement work should focus on understanding implementation barriers and incorporating fracture-risk assessment into existing post-falls pathways.