Abstract
Background:
The UK National Osteoporosis Guideline Group (NOGG) guidelines 2021 recommend that all older patients presenting to geriatric clinics or wards should have a FRAX assessment guide BMD measurement and referral for DEXA or starting of drug treatment.
Aims:
1) To increase the proportion of patients assessed by the acute frailty service (AFS) undergoing FRAX assessment to 85%.
2) Offer 85% of AFS patients with low-risk FRAX scores lifestyle advice.
3) Refer 85% of AFS patients with intermediate (below treatment threshold) FRAX scores for DEXA scans.
4) Refer 85% of AFS patients with high/intermediate (above treatment threshold) FRAX scores for bisphosphonate or monoclonal antibody treatment.
Methods: A quality improvement cycle was conducted at a Frailty service from November 2022 to January 2023 (retrospective) and April to July 2024 (prospective). An electronic bone health proforma was introduced with an education session at the start of the prospective phase. Data were collected during the prospective phase.
Results: The rate of FRAX score calculation increased from 35% to 61% (p<0.01), low risk patients offered lifestyle advice increased from 21% to 91% (p<0.01), higher risk patients referred for therapy increased from 63% to 90% (p>0.05).
Conclusions: Significant increase in FRAX completion, main barrier was height and weight availability for calculation. 100% above treatment threshold patients in the prospective phase were referred to treatment if appropriate i.e. not bedbound or end of life etc. Future cycle interventions will include height and weight estimation if necessary and data collection on whether treatment is initiated following referral.