244 Delays in DXAs: an audit on the ordering of DXA scans for fragility fractures in a level 3 university hospital

Abstract

Abstract Background Osteoporosis is a serious public health problem due to a rapidly ageing population. One in two women and one in five men will break a bone after the age of 50. Fragility fractures are common, costly and lead to significant changes to a person’s QOL. Many of these fragility fractures can be prevented by timely intervention by a Fracture Liaison Service (FLS). The Royal Osteoporosis Society (ROS) has a Summary of Clinical Standards for FLS’s to inform the best practice of managing bone health risk after a fragility fracture. These standards are underpinned by evidence demonstrating that they are clinically and cost-effective. The standards state that patients aged >50 with a new fragility fracture should be offered an assessment including a quality-assured axial DXA, within 12 weeks of fracture diagnosis. Methods The data set of the 847 fragility fractures identified by the FLS was analysed between January 2021 and April 2023. Of these confirmed fragility fractures, it was then assessed who had DXA scans booked and by whom. Results Of the 847 patients identified by FLS, 598 (70.6%) had been recommended to the GP to order a DXA scan, 8 (0.94%) had a DXA booked by the FLS, 133 (15.70%) already had a DXA performed and 26 (3.07%) were deemed that a DXA was not necessary and 1 (0.12%) had been booked by the clinical team. Conclusion According to this audit, most DXA scans are organised by the FLS writing to the GP to organise the DXA scan. We believe this leads to unnecessary delays in DXA scanning and places more pressure on GPs. This audit highlights the need for the ANP in FLS to collaborate with colleagues in other departments and specialities to help maximise the identification and treatment of people at risk of osteoporosis.