Bone Abstracts

Background: Fragility fractures in patients over 60 represent a major burden on emergency services and signal underlying osteoporosis requiring intervention. Emergency Department (ED) presentations provide a critical opportunity to initiate secondary fracture prevention, particularly in district general hospitals where resources are limited. This audit was conducted at Ealing Hospital to evaluate existing gaps in osteoporosis management following ED presentation and identify areas for improvement.

Methods: We conducted a retrospective audit of patients aged ≥60 presenting to the ED between 13 January 2026. Data were sourced from electronic patient records covering fracture occurrence, anatomical site, acuity, and admission status. Osteoporosis assessments criteria included: vitamin D, serum calcium, FRAX score documentation, DEXA arrangement, and concurrent steroid use. Follow-up was defined as DEXA arranged, bone-protective therapy initiated, or documented Fracture Liaison Service (FLS) input. Descriptive statistics were applied.

Results: Of 166 patients aged ≥60, 22 (13.3%) had a fracture documented. 20 fractures (90.9%) were acute, and 2 (9.1%) were chronic. These fractures included wrist/distal radius (n7, 31.8%), hip/pelvis (n5, 22.7%), hand (n4, 18.2%), humerus (n3, 13.6%), and vertebral/rib fractures (n3, 13.6%). 7 patients (31.8%) required inpatient admission ranging from 1 to 27 days, while 15 (68.2%) were discharged from the ED. 3 patients (13.6%) were on concurrent steroid therapy, representing a modifiable risk factor for bone loss. Vitamin D was measured in 10 patients (45.5%) and calcium in 9 (40.9%). FRAX score was documented in 1 patient (4.5%). A DEXA scan was arranged in 5 patients (22.7%), and bone-protective therapy (bisphosphonates) was initiated in 5 patients (22.7%). Only 9 patients (40.9%) received osteoporosis follow-up, with 13 (59.1%) receiving no follow-up or treatment to modify future fracture risk.

Conclusion: These findings reveal that despite an existing FLS, significant deficiencies in osteoporosis assessment and management at Ealing Hospital exist. ED fragility fractures likely represent only the tip of the iceberg in osteoporosis detection. Enhancing ED awareness, optimising referral criteria, and embedding osteoporosis assessment into acute fracture pathways are essential next steps to reduce risk of subsequent fragility fractures in this vulnerable population.