242 Optimising bone health assessment and management in Parkinson’s Disease: a closed loop quality improvement project

Abstract

Abstract Background People with Parkinson’s Disease (PD) are at increased risk of osteoporosis, falls, and fractures. An audit of our age related day hospital’s weekly PD Interdisciplinary Clinic (PDIC) assessment identified suboptimal management of bone health. We subsequently introduced a ‘bone health’ section to the proforma to identify areas of suboptimal bone health management warranting further investigation and/or intervention. Methods Cycle 1: Retrospective review of PDIC proformas and charts revealed multiple risk factors for falls and fractures and suboptimal management of bone health. A ‘bone health’ section was introduced to the proforma. Questions related to osteoporosis diagnosis, previous fractures, DXA scans, calcium/cholecalciferol supplementation, and anti-resorptive treatment. Cycle 2: Prospective data collection over four weeks using the PDIC proforma and ‘bone health’ section. Results Cycle 1: (N = 33), Cycle 2: (N = 12). Both cycles had similar patient demographics. Over 50% had orthostatic hypotension and/or identified falls risk medications. Over 70% had gait impairment, and over 66% had a history of falls. Cycle 1: 36% had known osteoporosis. Of these, 33% were not receiving osteoporosis treatment. 27% had a previous fragility fracture, 33% of these were not on osteoporosis treatment. 27% had a DXA scan. Cycle 2: 8.3% had known osteoporosis and 8.3% osteopenia. 42% were unsure of osteoporosis diagnosis. 33% had previous fracture, 75% of which were fragility fractures. 33% had a DXA. Areas of suboptimal bone health management warranting intervention were identified in 50% on the ‘bone health’ section. 25% were commenced on calcium/cholecalciferol supplementation. 8.3% were recommenced on denosumab. 8.3% were counselled on correct use of Denosumab. 8.3% had repeat DXA booked. Conclusion This closed loop QI project identified suboptimal bone health assessment in PD patients at risk of falls. The ‘Bone Health’ section had a positive impact, implementing low impact interventions to reduce fracture risk and associated morbidity/mortality.