Bone Abstracts

Background: Fragility fractures are a major geriatric health concern, with spinal fractures associated with increased morbidity, mortality, and subsequent fracture risk. Best practice guidelines recommend prompt investigation, initiation of osteoporosis therapy, and structured follow-up, often via fracture liaison services (FLS) and/or relevant teams. We conducted an audit to evaluate the care pathway for patients with spinal fractures in our NHS Trust.

Methods: A retrospective audit was performed on 70 patients sustaining spinal fractures. Data collected included demographics, mechanism of injury, presenting symptoms, clinical frailty scores, investigations (DEXA scans, blood work), initiation of osteoporosis therapy, and follow-up arrangements. Coding completeness, referral to therapy, surgical intervention, and falls assessment were also recorded.

Results: Of 70 patients, 52 (74%) were female and 18 (26%) male. Most fractures occurred following trauma (51/70), with incidental findings on imaging in 12 cases. The mean clinical frailty score was 5; 12 patients had documented dementia or delirium. Falls assessments were performed in 29 patients. Immediate management included therapy and pain referral in 51 patients, surgical intervention in 5, and 14 patients were transferred to other units of care. Investigations for osteoporosis were inconsistent: 24 underwent inpatient evaluation, 16 outpatient assessment, and only 16 patients had DEXA scans (13 female, 3 male). Full blood panels were performed in a single patient. Regarding bone health management, only 2 patients received a comprehensive plan, with partial plans in 4. Bisphosphonates were prescribed to 30 patients, calcium and vitamin D supplementation to 12, while 29 patients received no pharmacological treatment.16 patients attended bone clinics or rheumatology, 5 were referred to FLS, 13 had GP follow-up, and 18 had no documented follow-up.

Conclusion: This audit highlights significant gaps in the management of spinal fragility fractures, including under-investigation, inconsistent initiation of osteoporosis therapy, and fragmented follow-up. High-risk populations, particularly frail and cognitively impaired patients, are especially vulnerable to suboptimal care. Our findings highlight the need for structured, guideline-driven pathways, including systematic referral to relevant services, standardized investigation protocols, and comprehensive bone health plans, to improve patient outcomes.