Endocrine Abstracts

Background: NICE has issued the guidelines regarding the use of alendronate in the secondary prevention of osteoportic fragility fracture in women above 75 years in whom DXA scan is clinically inappropriate or not feasible and considered to have osteoporosis by the responsible clinician.

Objectives: We conducted an audit on inpatients at the James Paget University Hospital to examine whether patients are receiving the appropriate interventions as stated in NICE guidance.

Methods: We reviewed the lumbar and thoracic spine X-ray reports of 83 (57 females, 26 males) inpatients aged seventy five years and older, admitted between August 2008 and August 2009. Twenty-eight (20 females, 8 males) patients’ reports had one or more of the following words – wedge/compression, fracture, or loss of height suggesting osteoporotic fragility fracture. We had access to look into 17 (13 females, 4 males) patients notes.

Results: Only 38% (5/13) of the females received the appropriate medications (calcium, vitamin D and alendronate) as recommended in NICE guidance. None of the men (0/4) received the full secondary prevention. Four patients received either calcium and vitamin D or alendronate.

Discussion: A woman with a vertebral fracture has an increased relative risk (RR) of 4.4 for a further vertebral fracture, 2.3 for a hip fracture, and 1.4 for a wrist fracture and it is estimated that 180 000 osteoporosis related symptomatic fractures occur annually in England and Wales, resulting in significant morbidity, mortality and financial burden, of which up to 19% are preventable (www.nice.org.uk/TA161).

This audit highlights that a significant proportion of patients at high risk of fragility fractures are not receiving appropriate preventative medication despite recent NICE guidance of the potential benefits. It is imperative that awareness of this guidance is improved so that patients can benefit from the risk reduction offered by bisphosphonates such as alendronate.