3010 Improving the assessment and management of bone health on an acute frailty unit

Abstract

Introduction Fragility fractures are a significant cause of morbidity and mortality in the UK. An estimated 549,000 fragility fractures occur each year, with a significant financial and social cost. By identifying and treating those at risk we can reduce the incidence of fragility fractures. We wished to assess how we could optimise management of bone health in those presenting to our acute frailty unit (AFU). Method We conducted a retrospective review of patients admitted to AFU with falls on a background of frailty. 2 PDSA (plan, do, study and act) cycles were undertaken in 2023 and 2024 respectively. We audited if patients had a full assessment of bone health (calcium, Vitamin D levels and FRAX score) and if they had been started on appropriate treatment. Interventions included multiple educational sessions for members of the elderly medicine team, updated guidelines for primary and secondary prevention and concise poster guidelines visible on all elderly care wards. Results Over two cycles, we noted an improvement in bone health assessments among those admitted. By the end of our cycles, 48% had appropriate bone health bloods compared to 13% prior and 30% had a FRAX score calculated compared to 7% before. 33% of the patients had a clearly defined treatment plan for bone health compared to 0% at the start of the cycle. Conclusions 1. Education proved a moderately successful tool for increasing the awareness of bone health in frail patients admitted to AFU and also in increasing appropriate assessment and management of these patients. 2. Despite this, the majority of patient’s did not receive an assessment. Possible factors limiting this included time, clinical acuity and uncertainty about best management option. 3. This QIP has demonstrated the need for the development of a fracture liaison service to provide robust assessment and management in the frail population.