994 CURRENT SECONDARY PREVENTION AFTER HIP FRACTURE IN ENGLAND AND WALES—RESULTS FROM THE NATIONAL HIP FRACTURE DATABASE (NHFD)

Abstract

Abstract 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.