Fragility fractures-reviewof practice

Objectives: To evaluate whether patients with fragility fractures were appropriately reviewed by the fracture liaison service and treated in accordance with national guidelines. Background: Guidlines from NICE and The National osteoporosis guideline group (NOGG) were followed with regards to using FRAX scores to identify 10-year risk of fragility fractures and to determine the need for treatment and use of DEXA scan; treatment is by bisphosphonate therapy for indicated patients as per the guidelines. Contra-indications are eGFR below 35, GORD (or patients unable to sit up for 30 min) and hypocalcaemia. Methods: This was a retrospective audit, patients on the orthopaedic wards between 26/11/15 and 17/12/15 suspected to have fragility fractures were included. From the notes it was assessed whether the patients were reviewed by the osteoporosis specialist nurse; prescribed bisphosphonates and calcium/ vitamin D supplements; and whether they received DEXA scan. Results: 36 patients were identified with fragility fractures, all seen by the osteoporosis specialist nurses. 30/36 patients had fractured neck of femur (#NOF). 22/36 patients received bisphosphonates; of the 14 patients not given bisphosphonates, all had valid contraindications which were documented in the notes except for 4 patients. 7 Patients had DEXA scans, 35/36 patients received vitamin D. 32/36 patients received calcium; of the 4 not given calcium, 2 had renal disease, 1 deemed not to have a fragility fracture, 1 had calcium through PEG. Discussion: The system for identifying patients with fragility fracture was comprehensive. NICE guidelines were followed with regards to bisphosphonate therapy and vitamin D/ calcium supplementation. For 2 patients no reason was documented for not starting treatment and for 2 patients the reasons given were inadequate. Conclusion/Recommendations: To include in the existing #NOF proforma an eGFR warning, a tick list of risk factors for identifying osteoporotic fractures and to use a similar proforma for other fragility fractures. To expand the fracture liaison service to outpatient clinics; and FRAX score to be used for both in and outpatients to determine the need for DEXA Scan. Limitations: This is a retrospective audit with a small sample size that relies on documentation in the notes.