Title : Enhancing refracture prevention: Compliance with documentation of Australasian faculty of rehabilitation medicine guidelines for assessing and treating osteoporosis after neck of femur fracture
Abstract:
Background: Osteoporosis is characterized by low bone mineral density (BMD) and structural deterioration, increasing fracture risk, particularly hip fractures following minimal trauma. In Australia, osteoporosis affects 3.4% of the population, and its prevalence rises significantly with age, disproportionately impacting women. Hip fractures in osteoporotic patients have severe outcomes, including high mortality and long-term disability. Despite available treatments, osteoporosis remains undertreated, with only 43% of Australian patients receiving fracture prevention medications post-hip fracture. In response, New South Wales (NSW) developed the Osteoporotic Refracture Prevention (ORP) model to reduce refractures and improve care. This audit is aimed to evaluate the compliance with recommendation for osteoporosis management plan documented in patient discharge summaries.
Method: The audit was conducted in two parts: the first over 12 months (n=1712, neck of femur (NOF) fractures n=132) and the second over 6 months (n=833, NOF fractures n=57). Interventions implemented in November 2023 included educating Junior Medical Officers (JMOs) on the importance of including osteoporosis management in discharge summaries, creating a standardized discharge template, and tasking the Orthogeriatric registrar with contacting general practitioners (GPs) to communicate ORP plan. Data was collected from the hospital’s electronic medical record (EMR) system and analysed for the presence of a management plan in discharge summaries.
Results: The primary outcome, which was the documentation of management plans at discharge was significantly improved (37% to 56%, p=0.026) post intervention. Other observational data included discharges to residential aged care facilities (RACF), which decreased (65 to 16), with more patients discharged to home or to private rehabilitation (p=0.022). The percentage of administration of zoledronic acid from those who were followed up in the clinic increased significantly (22% to 40%, p=0.010), indicating better treatment adherence. However, follow-up rates at the ORP clinic decreased (44% to 26%), and there was no significant change in refracture rates (5.3% to 6%, p=0.644).
Conclusion: Targeted interventions significantly improved the documentation of osteoporosis management plans in NOF fracture patients, enhancing compliance with Australasian faculty of rehabilitation medicine guidelines. However, ongoing efforts are needed to address gaps in follow-up care and ensure comprehensive management for all patients. Further studies are required to assess long-term impacts on refracture rates.
