Bone Abstracts

Background: Bisphosphonates are commonly prescribed for osteoporosis and malignancy but carry a risk of osteonecrosis of the jaw (ONJ). National guidance recommends preventative measures including pre-treatment dental assessment, oral hygiene advice, and patient education. This audit evaluated compliance with ONJ prevention standards in primary care.

Methods: This audit was conducted within a general practice serving approximately 10,500 patients, of whom 120 were receiving bisphosphonate therapy. A random sample of 30 patients were selected. Data was collected on documentation of: (1) dental assessment prior to therapy, (2) oral hygiene advice, and (3) patient education regarding ONJ. Standards were based on SDCEP guidance March 2024, with a compliance target of 80% for each domain. Following the initial audit, our intervention was multifaceted it included a targeted teaching session, reinforcement of the guidelines to the practice pharmacists and highlighting feedback from the first audit cycle. A re-audit was performed after a 7-month period in which 10 additional patients were initiated on bisphosphonate therapy. At the second audit meeting, a patient information leaflet, adapted from SDCEP and Royal Osteoporosis Society (ROS) resources was introduced.

Results: The mean age of patients was 64 years; 86% were prescribed bisphosphonates for osteoporosis-related indications, with the remainder primarily for malignancy, most commonly breast cancer. Baseline compliance was low, with 0% of patients having documented dental assessment or ONJ education, and 13% receiving oral hygiene advice. Post-intervention, compliance improved to 90% across all domains.

Conclusion: A three pronged, low-cost intervention significantly improved compliance with ONJ prevention guidance in primary care. Pharmacy-led counselling during medication reviews was identified as a key driver of improvement. The introduction of a concise patient leaflet supported patient understanding and may help address the remaining 10% gap in compliance. Further work is required to achieve full compliance, with a focus on embedding these measures into routine workflows especially in areas where GP practices are in dental deserts.¹

References: 1. Englands Dental Deserts: The urgent need to level up access to dentistry A report commissioned by the Association of Dental Groups [Internet]. 2022. Available from: https://www.theadg.co.uk/wp-content/uploads/2022/05/ADG-Report_The-urgent-need-to-level-up-access_April-2022_V3.pdf