Bone Abstracts

Introduction: Osteoporosis remains a major public health concern affecting half of women and one fifth of men over the age of 50. Individuals who sustain a fragility fracture are at five times greater risk of a subsequent fracture within two years. Fracture Liaison Services (FLS) are the internationally recognised standard for secondary fracture prevention, providing systematic identification, assessment and management of patients over 50 presenting with fragility fractures. A FLS has been established at London Northwest University Healthcare NHS Trust (LNWUH) since 2017. The service identifies patients aged 50 with fragility fractures through orthopaedic pathways. Patients undergo risk assessment, blood tests and bone density assessment (DXA), with treatment recommendations provided accordingly. Complex or very high-risk cases are reviewed in specialist clinics. Follow-up at four and twelve-months monitors treatment adherence and optimises ongoing management. In October 2023, Pathpoint, a digital workflow solution, was implemented to automate patient identification, facilitate digital communication and streamline data collection. Prior to implementation, case identification and assessment relied on manual processes within fracture clinics, which were time-intensive and led to delays in patient assessment and treatment initiation.

Methods: Pre and post implementation pathways were analysed with respect to pathway process, time taken per task and impact on national Fracture Liaison Service Database (FLS-DB) key performance indicators (KPI) between 2022 and 2024.

Results: Following introduction of Pathpoint, improvements were observed in case identification (KPI 2) which increased significantly across both Ealing Hospital (EH) and Northwick Park Hospital (NPH) sites (0.4% to 83.4% for EH and 14% to 71% for NPH). Timely assessment within 90 days (KPI 4) also improved markedly, increasing from 0% to 60% at EH and from 40% to 73% at NPH. Staff feedback indicated improved workflow efficiency and reduced assessment time per patient (61 to 16 minutes per patient pre vs post implementation).

Conclusion: Implementation of the Pathpoint digital platform has significantly enhanced case identification, assessment timeliness and pathway efficiency within the LNWUH FLS. Continued optimisation, focusing on treatment initiation at first follow-up (KPI 10) and long-term medication adherence (KPI 11), will be essential to maximise the benefits of digital FLS systems and further improve secondary fracture prevention.