Primary prevention of fragility fractures in general practice

Introduction

Management of fragility fractures was estimated to have cost the NHS £4.4 billion in 2022. As the incidence of fragility fracture is predicted to rise along with the increase in population over age 65 in the UK, primary prevention is a necessary avenue to reduce its economic, social, and environmental impacts. Current best practice in the UK suggests that any female aged over 65 and male over 75 is at high risk of osteoporosis and should be assessed for the need for prevention of fragility fractures, including a QFracture 10-year risk calculation. Management for those identified may include lifestyle modifications, hormone replacement therapy, antiresorptive medications, and falls safeguarding.

Method

From a population of all patients registered at one GP surgery in the Northeast of England, those who experienced a fragility fracture in the past year were retrospectively analysed to determine if any assessment for fragility fracture risk was performed prior to the fracture occurring.

Results

Out of 37 people identified, 30 were at high risk of osteoporosis according to NICE guidelines. 17 out of the 30 did not have any discussion or coded assessment of their risk before the fracture occurred. Ten of these people were older than 75.

Conclusions

Current systems to identify and treat people with osteoporosis may be failing to pick up a significant proportion who go on to suffer a fragility fracture. As a result, the practice partners aim to implement a local protocol to assess risk of fragility fracture in all of their patients based on age.