Endocrine Abstracts

Background: University Hospitals Birmingham NHS Foundation Trust offers a comprehensive bone health assessment, through the Fracture Liaison Service (FLS), to individuals who sustain fragility fracture/s. Patients requiring assessment are identified daily through admissions from Accident and Emergency and Trauma and Orthopaedics. A bone density scan is requested for further investigations according to the FRAX tool to identify more accurately their fracture risk and to help define the management plan (ROS, 2019). However, the FRAX tool is a guide, and NICE guidance (2017) states that the tool can underestimate fracture risk. Therefore, for those patients considered to be low risk but with additional risk factors, DXA scan is arranged to better estimate their future fracture risk.

Aim: To assess the value of bone density scans in patients classed as low risk of sustaining a future fracture.

Methodology: A retrospective audit was completed using the FLS database for those who received a DXA scan (01 Jan 2020 – 18 June 2021) and were classed as low risk at baseline FRAX.

Findings: Between 01 Jan 2020 to 18 June 2021 a total of 137 patients received a bone density scan. Of the 137 patients, only 1 showed osteoporosis (NICE criteria for a T score < -2.5) and 23 had osteopenia (T score -1.0 - - 2.5). These 136 patients required no further management, therefore supports the recommendation from FRAX for lifestyle advice only.

Conclusions: We found that patients classed as low risk by baseline FRAX, regardless of additional risk factors, do not require a bone density scan as the result does not change the management plan. Low risk patients rarely show osteoporosis on DXA and therefore emphasising lifestyle advice is important without the need for radiological intervention. This reduces demand for DXA scans and additional patient hospital appointments.