Summary Hip fractures are strong risk factors for further fractures. However, using the National Hip Fracture Database, we observed that in England and Wales, 64% of patients admitted on oral bisphosphonates were discharged on the same and injectable drug use varies from 0–67% and 0.2%-83.6% were deemed “inappropriate” for bone protection. This variability requires further investigation. Introduction A key aim for the National Hip Fracture Database (NHFD) is to encourage secondary fracture prevention of the 75,000 patients who break their hip annually in the UK, through bone health assessment and appropriate provision of anti-osteoporosis medication (AOM). We set out to describe trends in anti-osteoporosis medication prescription and examine the types of oral and injectable AOMs being prescribed both before and after a hip fracture. Methods We used data freely available from the NHFD www.nhfd.co.uk to analyse trends in oral and injectable AOM prescription across a quarter of a million patients presenting between 2016 and 2020, and more detailed information on the individual type of AOM prescribed for 63,705 patients from 171 hospitals in England and Wales who presented in 2020. Results Most patients (88.3%) are not taking any AOM when they present with a hip fracture. Half of all patients (50.8%) were prescribed AOM treatment by the time of discharge, but the proportion deemed ‘inappropriate for AOM’ varied hugely (0.2–83.6%) in different hospitals. Nearly two-thirds (64.2%) of those previously taking an oral bisphosphonate were simply discharged on the same type of medication. The total number of patients discharged on oral medication fell by over a quarter in these five years. The number discharged on injectables increased by nearly three-quarters to 14.2% over the same period, but remains hugely variable across the country, with rates ranging from 0–67% across different units. Conclusion A recent hip fracture is a strong risk factor for future fractures. The huge variability in approaches, and in particular the use of injectables, in different trauma units across England and Wales requires further investigation.
Fracture Liaison Services (FLSs) are recommended healthcare models to deliver secondary fracture prevention and reduce the risk of subsequent fractures. Several studies have demonstrated the cost and clinical effectiveness of FLSs, but there is little real-world data on the impact of FLSs on subsequent hip fracture rates. A cohort of 50,214 patients from the national FLS database with an index fracture of the hip, spine, or other site England and Wales in 2017 was linked to the National Hip Fracture Database from 2017 to 2020 to identify those patients who went on to have a subsequent hip fracture. One in twenty (5.1%) of the 9,888 people in whom the index fracture was at the hip went on to suffer a second hip fracture within 3-4 years, despite receiving the support of an FLS. The risk of hip fracture was similar (4.7%) if the index fracture was at the spine, but lower at other sites (2.8%, p<0.001) and the interval shortest after an index hip fracture (1.1 years (0.4,2.0) p<0.001). The proportion of patients with a subsequent hip fracture was not lower by types of anti-osteoporotic medication. This work highlights the need for alternative anti-osteoporotic management strategies to rapidly decrease the risk of subsequent hip fractures for people seen by an FLS setting with levels of risk that are even higher for patients in areas which are still not served by an FLS.
Introduction National clinical audit seeks to enhance the quality of care of the 75,000 people who break their hip in the UK each year. A key aim for the National Hip Fracture Database (NHFD) is to encourage secondary fracture prevention through bone health assessment and the appropriate provision of anti-osteoporosis medication (AOM). We set out to describe trends in anti-osteoporosis medication prescription, and to examine the types of oral and injectable AOM being prescribed both before and after a hip fracture. Method We used data freely available from the NHFD www.nhfd.co.uk to analyse trends in oral and injectable AOM prescription across a quarter of a million patients presenting between 2016 and 2020, and more detailed information on the individual type of AOM prescribed for 63,284 patients from 171 hospitals in England and Wales who presented in 2020. Results Most patients (88.2%) were not taking any AOM when they presented with hip fracture. Half of all patients (49.9%) were prescribed AOM treatment by the time of discharge, but the proportion deemed ‘inappropriate for AOM’ varied hugely (0.2–83.6%) in different hospitals. Nearly two thirds (64%) of those who were previously taking an oral bisphosphonate were simply discharged on the same type of medication. The total number of patients started on oral medication fell by 11.4% over 5 years. The number started on injectable AOM almost doubled to 14.4% over the same period, but remains hugely variable across the country, with rates ranging 0–67% across different units. Conclusion A recent hip fracture is a strong risk factor for future fractures. If teams are to learn from each other’s experience and patients are to be protected against further fragility fractures the huge variability in approaches, and in particular to the use of injectables, in different trauma units across England and Wales requires further investigation.
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