Abstract Background/Aims Identifying and following up low trauma fractures (LTF) is key in diagnosing patients with underlying osteoporosis. National guidelines by the Royal Osteoporosis Society and National Osteoporosis Guideline Group recommend prompt assessment and treatment to prevent secondary fractures. Fracture liaison services (FLS) are designed to support this, but Royal Preston Hospital (RPH) currently has no FLS in place and, with current financial constraints, there is no means to progress a business case. This project evaluated whether osteoporosis is being considered in patients presenting with LTF in RPH. This was done by comparing elements of what an FLS would deliver to the current patient pathway, after presenting to the fracture clinic. Methods Patients aged 50 and over attending RPH fracture clinic in February 2023 with a LTF were identified using electronic clinic letters. Review of clinic letters, GP summary and hospital records were undertaken to collect data on: patient demographics, fracture type, coding, whether FRAX/DXA was done, who requested investigations and re-fracture occurrence. A driver diagram was produced to identify opportunities to improve the patient pathway. Quality improvement (QI) tools, including a driver diagram and stakeholder mapping, were used to identify key barriers and areas for intervention. Results A total of 84 patients who were aged 50 or over who sustained a LTF were included in the final analysis. The most common fracture was of the distal radius (n = 25), and the predominant ethnicity was White British (n = 76). None of the clinic letters documented that it was a LTF. Of the 84 patients, 73 (87%) had their fracture site coded correctly on their GP problem list. Among these, 40% had a FRAX or DXA assessment, compared to 27% in the uncoded cohort. 72% of the total 25 DXA scans were requested by the GP. 11 patients (13%) received active treatment after their LTF. 7 patients (8.3%) sustained a secondary fracture within the follow-up period; 5 had a DXA scan, and 1 had a FRAX assessment. Conclusion This QI project highlighted significant variation in post-fracture osteoporosis management in the absence of a local FLS. Accurate coding of fragility fractures in primary care was strongly associated with subsequent assessment and treatment. However, the overall low rates of FRAX use, DXA scanning and treatment initiation point to systemic gaps in secondary fracture prevention. The implementation of a full FLS is currently not an option due to financial constraints. This work supports how we can work with primary care to try to fill the gap. The initial focus is to improve fracture clinic communications to include “low trauma fracture” documentation, GP action to consider a bone health assessment and DEXA, and a patient action to signpost to the Royal Osteoporosis Society website. Disclosure H. Bashir: None. C. Cross: None. C. Rao: None. E. MacPhie: None.
Bashir et al. (Wed,) studied this question.