Abstract
Introduction:
Osteoporosis is a leading cause of morbidity in the elderly, with fragility fractures risking mortality, loss of independence and lengthy hospital stays. Patients admitted to hospital are often frail, with numerous risk factors for osteoporosis. The NOGG (2021) and NICE (CG146) recommend fracture risk assessment using the FRAX score in all women ≥65 years, men ≥75 years, and any adult ≥50 with risk factors such as previous fragility fracture, glucocorticoid use, smoking and high alcohol, low BMI, parental hip fracture, or relevant comorbidities. Despite clear guidance, FRAX scores often remain under-calculated, particularly in district general hospitals. This project aimed to increase FRAX assessments in eligible patients.
Method:
A retrospective data analysis was conducted over 6 weeks, reviewing all admissions to the geriatric ward of a district general hospital. Eligibility for FRAX was determined using NOGG/NICE criteria. Data collected included demographics, comorbidities and risk factors. Interventions were in 2 steps: an educational session for ward staff on osteoporosis, fracture risk and the assessment of eligibility for FRAX scoring, followed by visual aids via posters to serve as a reminder for assessments. Post-intervention data is to be compared with the baseline, as a prospective 6-week analysis.
Results:
Across 6 weeks, 97 eligible admitted patients were identified (53 males, 44 females), with an average age of 77.2 years. Of these, 26.8% had previous fractures, 11.3% were smokers, 7.2% were on long-term steroids, 27.8% had diabetes, and 3.1% had rheumatoid arthritis. Secondary osteoporotic features were present in 9.3%, while 12.4% reported excess alcohol intake. Overall, only 3.7% of patients had a FRAX score documented. At baseline, 9.8% were already receiving active treatment, while 12.2% were not on treatment despite meeting criteria. A further 68.3% were identified as requiring additional intervention following risk assessment.
Conclusion:
Results highlight a significant quality gap, with incredibly low baseline FRAX documentation in a high-risk geriatric population. We are currently in the intervention phase, having delivered staff education sessions and implemented visual reminders. Early feedback suggests improved awareness and engagement with FRAX scoring, improving patient safety. Continued observation and analysis will determine whether these measures translate into increases in FRAX completion and appropriate initiation of bone protection therapy.
Comments
Interesting project. It's…
Interesting project. It's tricky to sometimes get different staff members to engage in an initiative particularly at change over periods.
Staff education - could you highlight this initiative at doctor inductions into the department?
Could further reminders such as incorporating into board rounds or weekly meetings help the success e.g. FRAX fridays where eligible patients should have a calculation of their frax score?
Interesting stuff.
FRAX…
Great to see this…
Great to see this improvement in FRAX assessments being carried out, also these limitations and assumptions that may be made regarding patients' treatments would definitely cause an oversight in monitoring fracture risk. Would be interesting to see if for patients >80 or under palliative care to have a QFracture score as this gives the risk of a fracture ranging from in the next 1-10 years whilst FRAX gives a 10-year risk assessment.
Interesting audit on FRAX
Nice to see bone health management inclusion in the COTE ward in FGH. I agree that patient's admission proforma should include bone health assessment including FRAX (at least a link to the website) for those with risk factors, and it is very important to highlight that despite patient's already on current bone protection treatment but with clinical changes or risk factors i.e. recurrent falls or actual fragility fractures then re-FRAX should be considered. The challenge is the junior doctor's turnover but this can also ignite future expansion or improvement of its utilisation when it comes to the potential clinical audits under the department. And this is part of Comprehensive Geriatric Assessment, hence, junior doctors should be involved with! Well done!
Very interesting project,…
Very interesting project, hopefully utilising FRAX score will only increase following this. Perhaps it could be considered as a requirement on clerking geriatric patients that this is done or considered similar to how VTE is?