Abstract Introduction Falls are a common presentation comprising 17% of all ED attendances in older people and can result in harm including fragility fractures (FFs). FFs lead to pain, functional decline, deconditioning, and high mortality. Validated tools such as FRAX can increase prescribing of antiresorptive medications (ARM), reducing harm. Comprehensive geriatric assessment (CGA) is the gold standard for assessing and managing geriatric syndromes including falls and can include fragility fracture risk assessment. Method: An audit was conducted of all inpatients over one day on Colwell Ward at Isle of Wight NHS Trust. Patients were screened meeting NICE criteria for Bone Health Assessment (BHA). Notes were reviewed for evidence of FRAX scores or BHAs. Bloods were reviewed for vitamin D and calcium. Drg charts, medicine reconciliations, and GP records were screened to see if vitamin D, calcium, and anti-resorptive medications were prescribed previously. Following the audit FRAX scoring has been included in the CGA being piloted by the acute frailty team. Results Of 30 inpatients, 100% met NICE criteria for BHA. Mean and median age was 85 (72–96). 63.3% were female (19/30). 16.7% had a history of osteoporosis or osteopenia (5/30). 6.7% (2/30) had a note mentioning BHA in their medical notes, however zero patients had had a FRAX score calculated. 46.7% (14/30) had vitamin D checked and 93.3% (28/30) had had calcium checked. 6.7% (2/30) were already on ARM and the same percentage were started on ARM that admission. 56.7% (17/30) had vitamin D and calcium prescribed on their drug charts. Conclusion All patients met NICE criteria for BHA however few had FRAX scores completed. This may lead to avoidable fragility fractures. Reasons for few BHAs are likely multifactorial. Embedding FRAX within the CGA increases opportunities to identify at-risk patients. Re-audit is recommended after the CGA has been fully implemented locally.
Soma et al. (2026) studied this question.