taking care of you kingston hospital nhs trust nhs secondary prevention of osteoporotic fragility...
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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
Results
% of Patients
Time
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Kingston Hospital NHS Trust
NHS
TAKING CARE OF YOU
Kingston Hospital NHS Trust
NHS
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
Thank You Happy New Year
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.