Improving Bone Health in a Frailty Department: A Quality Improvement Project on FRAX Utilisation

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Dr Harriet Hamzelou, Dr Ee-Tienne Ong

Blackpool Victoria Hospital

Abstract

Background:

Fragility fractures are a major source of morbidity and mortality in frail, older adults (1). Early identification of osteoporosis risk allows for timely referral, investigation, and management. Baseline practice in the Frailty Department showed no use of FRAX (fracture risk assessment tool), resulting in missed opportunities for prevention (2).

Aim:

To increase use of FRAX within the Frailty Department to guide referrals to rheumatology, dual-energy X-ray absorptiometry (DEXA) scanning, or initiation of immediate treatment.

Methods:

Baseline data collection was undertaken to measure FRAX usage and referral rates. Two interventions were introduced:
1. Departmental teaching sessions to raise awareness of FRAX and its clinical application.
2. Posters placed around the department as visual prompts.

Data was re-collected following each intervention to monitor impact.

Results:

After initial interventions, FRAX use improved, with more patients being assessed and appropriate referrals made. However, repeat data collection revealed subsequent decline, with FRAX use falling. This highlights that while educational and visual interventions can generate short-term improvements, they were insufficient to embed sustained practice change.

Conclusion:

This QIP demonstrates the challenges of implementing and maintaining use of risk assessment tools in a busy clinical environment. While simple interventions increased initial uptake, long-term improvement requires structural change. Future work should focus on integrating FRAX into existing departmental pathways, such as admission proformas, particularly in patients presenting with falls. This could ensure consistent and sustainable assessment of bone health in frail patients.

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