Bone Abstracts

Background: Fragility fractures represent a critical opportunity for secondary prevention of osteoporosis; however, translation of guideline-based care into practice remains inconsistent. Structured models such as Fracture Liaison Services (FLS), advocated by the International Osteoporosis Foundation Capture the Fracture programme,¹ aim to standardize identification and management of at-risk patients. We evaluated local practice against trust and national standards.

Aim: To assess adherence to osteoporosis assessment guidelines in women over 55 presenting with low-impact rib and wrist fractures, and to identify gaps relevant to secondary fracture prevention pathways.

Methods: A retrospective review of 146 women (55 years) presenting to the Emergency Department (ED) or Minor Injuries Unit (MIU) over six months, excluding high-impact injuries and known osteoporosis. Data on investigations, DEXA scanning, and management were extracted from electronic records.

Results: 13% of patients underwent DEXA scanning following presentation; of these, 47% had osteoporosis and 37% osteopenia. No patient received a complete biochemical assessment in line with trust clinical guidelines, and 21% had partial biochemical investigations performed. Patients presenting ED were more likely to undergo biochemical testing than those seen in MIU (55% vs 5%). The majority (92%) were managed conservatively, with minimal evidence of structured follow-up or lifestyle intervention.

Conclusion: This audit demonstrates gaps in the identification and assessment of patients at risk of osteoporosis following fragility fractures, representing missed opportunities for secondary prevention. The high diagnostic yield of DEXA highlights the clinical significance of these missed assessments. These findings are consistent with the absence of a coordinated secondary fracture prevention pathway and support the implementation of structured models such as FLS to standardize care. Limitations include retrospective design, single-center data, and potential under-documentation.

Quality Improvement Implications: Implementation of standardised referral pathways, including primary care signposting and consideration of an FLS-aligned model, alongside targeted education, may improve adherence to guidelines.

References: 1. Javaid MK et al. Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture Best Practice Framework tool. Osteoporosis International. 2015 Nov;26(11):2573-8. 2. Compston J. NOGG and NICE: new guidelines and quality standards for osteoporosis. Maturitas. 2017 Dec 1;106:97-8.