Implementing Frax based Osteoporosis Risk stratification across Geriatric wards in St Cross Hospital Rugby

Introduction:
Osteoporosis affects approximately 3.5 million individuals in the UK, with prevalence increasing with age—particularly among women over 75. Hip fractures carry a one-year mortality rate of nearly 33%, underscoring the importance of primary prevention over reactive treatment. However, many elderly patients do not proactively engage with their GP regarding bone health.

Objective:
This audit aimed to

• Identify elderly inpatients at elevated risk of osteoporotic fragility fractures using the FRAX tool
• Communicate these findings to their GPs to support early intervention.

Methodology:
Two audit cycles were conducted at St Cross Hospital, Rugby:

• Cycle 1: 59 inpatients across three geriatric wards (Autumn/Winter 2024)
• Cycle 2: 36 inpatients across two geriatric wards (Spring 2025)

Inclusion criteria: age <90, Inpatients
Exclusion criteria: age >90, current use of bone-sparing agents, prior fractures, malignancy, or palliative care.
Data were extracted from electronic patient records, focusing on demographics, medical history, risk factors, and FRAX score components.

Standard and Guidelines:

Local guidelines and national osteoporosis guidelines were used

Both recommend the use of the University of Sheffield’s FRAX tool for risk assessing osteoporosis in higher risk patient groups

Results:

• FRAX score usage increased between cycles, yet only 12.5% of eligible patients had scores calculated and relayed to their GPs.

Interventions which resulted in the improvement included targeted emails, updated clerking templates, and regular teaching sessions for clinical staff.

Limitations:

• Reduced sample size due to one geriatric ward redeployment to a T&O ward
• Limited continuity among rotating resident doctors

Recommendations:

• Enhance staff awareness through frequent posters and teaching
• Embed FRAX prompts in clerking templates
• Encourage documentation of FRAX scores in GP discharge letters
• Conduct a third audit cycle to assess sustained improvements

References:

1. Royal Osteoporosis society: https://theros.org.uk/about-us/media-centre/media-toolkit/#:~:text=3.5%20million%20people%20in%20the%20UK%20are%20estimated,get%20older%2C%20especially%20for%20women%20around%20the%20menopause
2. Fracture Risk Assessment (FRAX) tool frax.shef.ac.uk/FRAX/tool.aspx?country=1 [28/08/2025]
3. National Osteoporotic Guideline: https://www.nogg.org.uk/full-guideline {accessed 28/08/2025]