Evaluating the adherence to the risk assessment and prophylaxis of fragility fractures in stroke patients at University Hospital Southampton

Cerejo, E., Elserafy, A., Ghosh, B., Veighy, K. and Marigold, R. (2024) Evaluating the adherence to the risk assessment and prophylaxis of fragility fractures in stroke patients at University Hospital Southampton. International Journal of Stroke, 19 (3 Suppl.). (doi:10.1177/17474930241300284).

Abstract

Introduction: osteoporosis and bone health is not well managed or often addressed inpatients who have suffered a stroke. We aimed to review our currentpractice to see if improvements could be made.

Method: a snapshot of patients admitted to the stroke unit was performed inFebruary 2024. This ensured a manageable sample size which reflectedclearly and honestly the adherence of fragility fracture risk assessment. 26patients were included, and each was asked a focused set of questionsaimed at calculating a FRAX score.

Results: 26 patients5 (61%) patients were on the correct level of intervention fortheir calculated fragility fracture risk, whilst 9 (39%) required moreintervention. All patients receiving the correct therapy response werealready prescribed before this admission.9 patients were at low risk (36%). 8 were at intermediate risk (32%). 6were at high risk (24%) and 2 were at very high risk (8%). For those whowere at intermediate risk and required a bone mineral density scan, nonehad been performed or requested at that time. 11 patients were prescribedbone protection including bisphosphonates (n=9) and vitamin Dsupplements (n=11), and had previous osteoporosis with 7 having hadprevious fragility fractures.

Conclusions: This improvement project highlights the importance of fragility fracture riskassessment in routine clinical practice. Only 61% of patients received boneprotection as per NOGG guidelines, and those at highest risk did not have aBMD scan or expert opinion. Further education and reaudit is needed toimprove adherence to guidelines.

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