Informing secondary fracture prevention for patients from a care home setting

Jane Kelly; Joanne Livingstone; Susan Morris; Rachel Eckert; Danielle Bishop; Jacalyn Elliott; Karen Taylor; Patricia Stevens; MK Javaid; Sarah Connacher

doi:10.1530/obabs.08.P36

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Bone Abstracts (2026) 8 P36 | DOI: 10.1530/obabs.08.P36

OP2026 Poster Presentations Clinical Audits and Service Improvements (40 abstracts)

Informing secondary fracture prevention for patients from a care home setting

Jane Kelly ¹ , Joanne Livingstone ¹ , Susan Morris ¹ , Rachel Eckert ¹ , Danielle Bishop ¹ , Jacalyn Elliott ¹ , Karen Taylor ¹ , Patricia Stevens ¹ , MK Javaid ^1,2 & Sarah Connacher ¹

Author affiliations

¹Oxfordshire Fracture Prevention Service, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom;²NDORMS, University of Oxford, Oxford, United Kingdom

Background: Assessing bone health for care home residents identified with a non-hip fracture is often challenging as patients cannot be assessed in person. Our previous pathway relied on clinical notes and blood test results to guide bone protection choices. We evaluated a brief questionnaire sent to the care home to assist in guiding local treatment choices, particularly around suitability for oral bisphosphonates.

Method: A questionnaire was co-developed between the FLS and our Care Home Support Service. The questionnaire included practical questions relevant to safe administration of oral bisphosphonates: whether residents could sit out of bed before taking tablets; whether they could reliably take a weekly medication with a glass of water before breakfast without distress; and whether they experienced heartburn or indigestion. A malnutrition score and use of calcium and vitamin D supplements was included. The questionnaire was distributed to care home staff between April 2024 and December 2025 and used to inform the treatment recommendation. We used treatment status at 16 weeks from a remote prescription check as the primary outcome and Fisher Exact test to compare differences.

Results: Seventy one questionnaires were distributed and 30 (42%) were returned. Fewer patients with returned questionnaires had died by 16 weeks compared to those without a returned questionnaire (2/30 (7%) vs 9/34 (26%) P 0.05). The comparison between treatment recommended and treatment status at 16 weeks is shown in the table.

Table 1. Table treatment decision and 16-week treatment status in surviving patients with and without returned questionnaires
Surviving patients with returned questionnaires	16-week treatment status
Treatment recommended:	Dmab	Oral	Nil
Denosumab (n13)	6 (46%)	3 (23%)	4 (31%)
Oral (n8)	0	7 (88%)	1 (12%)
Surviving patients without returned questionnaires
Treatment recommended:	Dmab	Oral	Nil
Denosumab (n15)	9 (60%)	2 (13%)	4 (27%)
Oral (n4)	1 (25%)	3 (75%)	0

Conclusion: We have developed a questionnaire for care home staff to fill in and return to us to aid FLS decision making. Further work is needed to test its value in the FLS setting. However, as nurses we have found the information gained has been valuable in helping us to make more robust, individualised, patient focussed bone protection treatment recommendations.