OP2026 Poster Presentations Clinical Audits and Service Improvements (40 abstracts)
Addressing gaps in bone health management after hip fracture: A quality improvement project in a district general hospital
Zarah Wilson 1 , Mahwish Naureen 1 , Azhar Saeed 1 , Carol Mosey 1 , Sherzah Jamal 1 , Madhavi Nair 1 , Muskan Khatoon 1 , Hashim Abdelrazik 1 , Chidera Ajaero 1 , Ehizokhale Okhibhamen 1 , Geraint Williams 1 & Sandipika Gupta 2
1North Manchester General Hopsital, Manchester, United Kingdom;2Pennine Acute North West GP Deanery, Manchester, United Kingdom
Background: Hip fractures in the elderly are a significant cause of morbidity and mortality, largely driven by untreated osteoporosis. Despite robust evidence and national guidelines recommending intravenous zoledronic acid as a first-line secondary prevention to reduce re-fracture risk by approximately one-third, its real-world use remains inconsistent. This quality improvement project at a district general hospital evaluated baseline IV Zoledronic use and assessed the impact of a newly introduced rapid vitamin D loading policy to enable timely parenteral treatment before discharge.
Methods: A three-cycle quality improvement project (QIP) was conducted using retrospective and prospective data from a district general hospital. The neck of femur fracture database (patients aged ≥60 years, N30 (first cycle), N30 (second cycle and N80 third cycle) was used for audit cycles:
Cycle 1 (20202022): Retrospective clinical audit evaluating pre-policy practice. Cycle 2 (2024): Post-policy implementation cycle assessing impact of rapid vitamin D loading policy on IV Zol use. Cycle 3 (2025): Re-evaluation one-year post-implementation to assess sustainability and outcomes after Plan-Do-Study-Act (PDSA) cycles.
Results: Cycle 1 revealed only 17% received IV Zoledronic. Barriers identified were vitamin D testing delays (30%), logistical issues (23%), and deaths prior to infusion (40%). Following the 2024 introduction of a Standard Operating Procedure for rapid vitamin D loading (≥160,000 IU cholecalciferol over 7 days) with structured pre- and post-infusion screening, Cycle 2 achieved 100% compliance with IV Zoledronic administration within 58 days post-surgery. Cycle 3 confirmed sustained adherence, with 98.75% receiving appropriate vitamin D loading and checklist completion, and 100% timely calcium monitoring. Although vitamin D levels were unavailable at infusion in 67.5% of cases, the rapid loading protocol mitigated treatment delays. Communication with general practitioners occurred in 98.5% of discharges. Outcomes included a low 6-month re-fracture rate of 3.33% and mortality of 6.25%.
Conclusion: Implementing rapid vitamin D loading prior to discharge significantly improves IV Zoledronic acid uptake, aligns local practice with national standards, and addresses key barriers to timely bone protection. This protocol enhances bone health management in hip fracture patients, potentially reducing re-fracture risk and associated morbidity in a DGH setting.
Volume 8
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Bone Abstracts
ISSN 2052-1219 (online)
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