Quality Improvement Project on Fragility Fracture Risk Assessment using FRAX score in Older Adults in Inpatient Psychiatry Unit

Introduction

Annually, around 130,000 people in Wales are reported to have at least one fall incident. Existing evidence suggests that Mental Health inpatient units, on average exhibit higher incidence of fragility fracture than acute hospital wards which could be contributed by medication such as antipsychotics and anti-depressants. Consequently, a quality Improvement project was formulated to evaluate fragility fracture risk among Elderly inpatient Mental Health unit and to analyse their adherence of treatment to the National Standards.

Method

Patients admitted to old age psychiatry ward at Bro Cerwyn– Hywel Dda Health Board from December 2024 to February 2025 were approached for the study. Electronic Health records of 25 eligible patients were reviewed to collect data on comprehensive medical history. Baseline results were assessed against clinical Guidelines delineated by National Institute for Health and Care Excellence (NICE) and The National Osteoporosis Guideline Group (NOGG). A PDSA cycle was implemented incorporating fracture risk assessment in routine ward template, posters and departmental teachings. In March 2025 second cycle was undertaken after implementation of interventions using the same methodology.

Results

The audit consisted of comparable male and female population (56% vs 44%) with a mean age of 76 years. FRAX score analysis demonstrated that 12% and 4% of participants exhibited high and very high risk, respectively, of experiencing fracture within subsequent 10-year period. At the baseline audit it was observed that 48% of participants were treated in accordance with the guidelines. The subsequent audit cycle post implementation of interventions demonstrated a substantial increase in guideline adherence to 76%.

Conclusion

The elevated FRAX scores underscore the importance of incorporating this assessment into routine screening of elderly patients with mental health conditions. Prompt identification and treatment according to the national guidelines can reduce fracture related morbidity, thus enhance patient outcome and overall quality of life.