1. 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

2. 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

3. 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

4. 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

5. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS Audit Standard 100% 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)

6. 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

7. 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%)

8. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS Results % of Patients Time

9. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS Mar 07 Intervention: Audit results presented at department meetings to raise awareness Jun 07 Intervention: Nursing staff / Matron prompting Jnr Dr’s/ Educating pharmacists Sep 08 Intervention: Regular emails in circulation Apr 09 Intervention: Included in orthopaedic induction for all new Jnr Dr’s Sep 09 Intervention: Reminder posters / Specific osteoporosis teaching for all Dr’s Apr 11 Intervention: New drug charts to be implemented

10. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS

11. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS ↵ ↵ ↵ A B C A - awareness raised B - regular emails C - posters and structured teaching introduced % of Patients Time

12. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS Future Developments New drug chart Continuation of old interventions Re-audit

13. 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

14. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS Thank You Happy New Year

15. TAKING CARE OF YOU Kingston Hospital NHS Trust NHS References NICE 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.