Use of the FRAX Screening Tool to Assess Fracture Risk in a Long-Term Care Facility

Abstract

The primary objective of this study was to determine the percentage of nursing residents at high risk of fracture as determined by FRAX score, calculated without bone mineral density (BMD) data. The secondary objective was to quantify FRAX components able to be ascertained through pharmacist chart review. Retrospective chart review. 130-bed long-term care facility in Arizona. Inclusion criteria comprised designation as a skilled nursing facility, residents older than 50 years of age, and postmenopausal, if female. Exclusion criteria comprised current osteoporosis diagnosis/treatment, and hospice. Eighty-eight residents were screened, and 52 completed the study. The FRAX clinical risk assessment tool was used without incorporation of BMD data to determine 10-year risk of major osteoporotic and hip fracture. FRAX components unable to be determined by chart review were recorded. The primary outcome measure was calculated FRAX score for each participant. The secondary outcome measure was component(s) of FRAX unable to be ascertained via chart review. 90.3% of participants had high (≥ 3%) 10-year risk of hip fracture and 55.8% had high (≥ 20%) 10-year risk of major osteoporotic fracture. FRAX components unable to be ascertained through chart review included family history of hip fracture (absent from 51.9% of charts) and/or ethanol use (absent from 3.8% of charts). Nursing facility residents are at high risk for fracture as determined by FRAX, without BMD data. The ability to determine FRAX scores via pharmacist chart review demonstrates an opportunity for pharmacist involvement in long-term care fracture risk screening.