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TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Secondary Prevention of Osteoporotic Fragility Fractures - results from 5 years of audit data
Hamid Abboudi, Stella Woodward, Thomas White, Natalia Spierings,
Palanisamy Ramesh
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Background
• Fragility fracture – a fracture resulting from a fall from a standing height or less
• Osteoporosis is the commonest cause of fragility fractures
• Risk factors for osteoporosis include: Postmenopausal women, malnourished, under weight, immobility, Crohn’s disease, fragility fractures, untreated premature menopause, ankylosing spondylitis, rheumatoid arthritis
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Background
• Oestrogen suppresses bone resorption by reducing osteoclast activity and promotes bone formation through osteoblast activity
• Bisphosphonates reduce bone resorption by inhibiting the action of osteoclasts
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Aim
• To establish bone protection prescribing rates in line with NICE (2005) guidelines, to prevent secondary fragility fractures
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Audit Standard100% of female patients over 75 years of age who have suffered a non-traumatic fragility fracture should be on bone protection for secondary prevention of further fractures:
•Alendronate 70 mg weekly (Risedronate and Etidronate )•Calcichew 1 tablet bd (400 IU cholecalciferol and 1250 mg calcium carbonate)
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Methods
• Prospective case note review
• All female patients over 75 years of age who sustained a fragility fracture
• 6 Audit cycles were performed from March 2007 – April 2011
• Each audit period was 3 months long
• Interventions implemented between cycles
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Results
• 311 discharge summaries were reviewed over the 5 year period
• The mean age of patients was 84 years
• Fractured neck of femur is the commonest fragility fracture in our cohort (74%)
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
↵
↵
↵
A
B
C
A - awareness raisedB - regular emailsC - posters and structured teaching introduced
% of Patients
Time
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Future Developments
• New drug chart
• Continuation of old interventions
• Re-audit
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
Learning Points• Repeated audit cycles with appropriate
interventions improve service provision
• Effective communication using a variety of mediums can lead to improved clinical outcomes
• We must strive to educate and communicate specialty specific goals during junior doctor rotations
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
ReferencesNICE TA160 – Secondary prevention of
osteoporotic fragility fractures
http://www.nice.org.uk/niceMedia/pdf/2005_001_secondary_osteo.pdf
Lyles, KW, Colon-Emeric CS, Magaziner JS et al. Zoledronic acid and Clinical Fractures and Mortality after Hip Fracture NEJM 2007 10.1056/NEJMoa074941.