Bone Abstracts

Background: The United Kingdom experiences over 550,000 fragility fractures annually, with direct medical costs rising from 1.8 billion in 2000 to 4.4 billion in 2022. Geriatric admissions following a fall represent a critical window for secondary fracture prevention. NICE NG249 (2025) and QS86 mandate a comprehensive falls assessment including formal osteoporosis risk assessment for all hospital inpatients, with NICE CG146 and NOGG 2024 recommending FRAX to estimate 10-year absolute fracture risk. Despite this national guidance, baseline audit on our geriatric wards identified a significant gap in FRAX documentation, suggesting a persistent gap in secondary fracture prevention across inpatient settings.

Methods: A two-cycle quality improvement project was conducted on a geriatric ward using retrospective case note review. Adults aged over 50 admitted with a fall as their presenting complaint were included; those with a prior osteoporosis diagnosis, fast-track discharge, or receiving palliative care were excluded. Thirty patients were reviewed over a three-week period per cycle. The primary outcome was documented evidence of a FRAX assessment within the patient record. Following Cycle 1, a targeted educational intervention was delivered comprising a clinician teaching session on NICE guidance, fracture risk management, and practical FRAX completion such as clarifying that FRAX can be performed without prior DEXA scanning. Educational posters were disseminated across the geriatric wards. Cycle 2 repeated the case note review to assess impact.

Results: In Cycle 1, 9 of 30 patients (30%) had a documented FRAX assessment (mean age 84.5 years; 57% female). Following the intervention, Cycle 2 demonstrated that 19 of 30 patients (63%) had a documented FRAX assessment (mean age 85 years; 60% female), representing a doubling of completion rates.

Conclusion: A low-cost educational intervention doubled FRAX completion from 30% to 63%, demonstrating meaningful and achievable improvement. However, completion falling short of 100% indicates education alone is insufficient. Future cycles should explore structural interventions such as embedding FRAX into the clerking proforma or discharge checklist to drive compliance towards 100%. Trusts must also consider whether DEXA capacity can meet increasing downstream demand, and whether bisphosphonate initiation on clinical grounds alone should be considered where DEXA availability is limited.