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Abstract

Introduction: Osteoporosis is defined as a reduction in bone mineral density resulting in reduced bone strength and increase the risk of fractures. Osteoporosis is a silent condition and often diagnosed following a fracture which has a huge impact on person's life. The aim of this feasibility study was to measure the prevalence of fragility fractures in all patients above 50 years of age according to Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract and apply quality improvement methodology to improve osteoporosis care. Method: This was a retrospective observational study to complete analysis for all known patients above age 50 years with diagnosed osteoporosis, known fragility fracture or prescribed osteoporosis treatment according to a General Practice database. General Practice staff was actively involved to implement quality initiatives. The pilot study was classed as service evaluation project according to health research authority decision tool. Results: The practice has 6300 patients on 1st Oct 2017 and 320 were included but 6 patients were excluded. Analysis was completed for 314 patients. The mean age of studied cohort (above 50 years age) was 75.5±10.5 years and 66.9% (210/314) were female. Mean number of co-morbidities for the studied population was 4.4±2.8. 66% (208/314) patients were on polypharmacy and the mean number of drugs was 6.8±4.2. 45.5% (143/314) had recorded fracture and of that 83 % (116/140) were classed as a fragility fracture (vertebra, wrist, hip, humorous and pelvis). 89 patients were on osteoporosis drugs, 44% (51/116) patients diagnosed fragility fractures were on appropriate treatment. 33.4% (40/116) patients were not treated according to guidance and 7.3% (23/314) were prescribed osteoporosis drugs inappropriately. 43.6% (137/314) patients were discussed as part of quality initiatives and were treated to guidance. Conclusion: This study suggests that an average practice of 6000 patients could have 2% prevalence of fragility fractures and one-third may not be treated to guidance. Regular monitoring of practice data and implementing quality initiatives enhance autonomous osteoporosis care by general practice doctors. Similar intervention is needed more widely to prevent a second fracture.