Bone Abstracts

Background: Inadequate dietary calcium intake is a modifiable risk factor for impaired bone mineralisation and increased fragility fracture risk. Within Fracture Liaison Services (FLS) and Bone Clinics, calcium assessment is frequently inconsistent, variably documented, and constrained by clinical time pressures. This limits structured health promotion, safe supplementation guidance, and optimisation of bone health within multidisciplinary osteoporosis care.

Aim: To design, implement and evaluate a nurse-led digital tool developed to standardise dietary calcium assessment by clinicians and patients, promote a food-first approach to calcium optimisation and so support safe clinical osteoporosis management.

Methods: The tool was developed by a Fracture Liaison Service Clinical Nurse Specialist to address workflow inefficiencies and patient knowledge gaps in secondary care. It was built using UK Composition of Foods Integrated Dataset (CoFID) values to ensure nutritional accuracy. Development included consultant endocrinologist review and local dietetic input to align with UK osteoporosis and nutritional guidance. The tool captures structured dietary intake across common food groups, calculates estimated daily calcium intake, and generates immediate personalised feedback against recommended thresholds. It supports a food-first approach while guiding appropriate supplementation and flagging risk of excessive calcium intake, particularly where supplements are co-prescribed with osteoporosis pharmacotherapy. Designed in plain English with an accessible, user-friendly interface, the tool was embedded into FLS consultations at a large NHS teaching hospital and made publicly accessible via the Trust website for professional and patient use.

Results: Implementation standardised calcium assessment across FLS consultations, replacing subjective estimation with structured measurement and improving documentation consistency. In the first 90 days of public deployment, the tool received 1,816 page views from 1,217 unique users, with a mean engagement time of 73 seconds per session, suggesting active user engagement with the tool. The tool enabled targeted dietary counselling, safer supplementation decisions, and more focused multidisciplinary discussions around bone health optimisation. Patients reported improved understanding of dietary calcium sources and greater confidence regarding supplement use.

Conclusion: This work demonstrates how nurse-led digital innovation, strengthened by multidisciplinary expertise, can enhance dietary bone health promotion, reduce unwarranted variation in osteoporosis assessment, and support safe osteoporosis management. The model is readily scalable across osteoporosis services nationally.