3118 NOGG guidelines and application in practice: analysis of 3 years of NHFD data and bone health service provision at Royal Albert

Abstract

Introduction National Osteoporosis Guideline Group (NOGG) guidelines published in 2022 significantly changed practice in orthogeriatric setting with recommendation for early treatment to address ‘imminent fracture risk’ and recommendation for greater use of injectable therapies for those at ‘very high fracture risk’. Intravenous zolendronate is now considered first line treatment, particularly post hip fracture but additional services for provision of injectable therapies have not been created to address this. The aim of this work was to analyse treatment choices for patients entered on National Hip Fracture Database (NHFD) for bone protection and assess current service provision against ongoing need. Method Data was collected retrospectively, using NHFD dataset for Royal Albert Edward Infirmary over 3 year period (2022–2024). Details of treatment choice were analysed across the 3 years and service provision for continuation of injectable therapies assessed against patient need. Results There were a total of 420 in 2022, 432 in 2023 and 381 in 2024 patients who were entered on the NHFD locally. In 2022, 192 patients (45%) of patients were discharged on oral bisphosphonate, whereas this number went down to 174 (40%) in 2023 and only 22 in 2024 (6%). Meanwhile, use of zolendronate nearly tripled from 56 (13%) in 2022 to 149 (39%) in 2024. Denosumab use also increased from 75 (18%) in 2022 to 107 (28%) in 2024. Overall, more than two thirds of patients were discharged home on injectable antiresorptive therapy in 2024 following a hip fracture. Conclusions Updated guidelines on optimal bone protection after hip fracture advise greater use of injectable antiresorptive drugs. National initiatives should focus on ensuring equitable access to these treatments both via hospital day case unit provision but also via delivery of injectable therapies for osteoporosis in community, as we aim to deliver more healthcare outside of hospital environments.