Many osteoporosis units are now identifying low impact fracture patients at presentation and assessing them for osteoporosis risk using a nurse led fracture liaison service (FLS); we established such a service in July 2002. Unfortunately many patients previously admitted with hip fractures have never been assessed, but are at high risk of future fracture. Outlined below is an audit of case finding using the theatre database to identify these patients.

All fractured neck of femur cases from 1999 to 2002 were identified on a theatre excel database. We utilised our Hospital Information Services System (HISS) to exclude those who had subsequently died. Current address and other personal/GP details were also found using HISS. Patients under 80 years of age received a questionnaire on osteoporosis risk factors, treatment and subsequent fractures and were invited for a Dexa scan.

Results: 675 patients were identified, of which 291 (43%) died. We were unable to obtain details on 74 (11%) patients. 96 patients under 80 years were invited for a Dexa. 45/96 replied to the letter, 36/45 agreed to a scan. 9/45 declined. Only 6/96 had a scan from GP previously & 8 had been commenced on therapy since fracture (3: Calcium/D3 supplements, 4: bisphosphonates and 1: both). 32 had a Dexa following the audit (M/F – 9:23). 4 (11%) did not attend. 21 (65%) were osteo-porotic, of which only 2 were taking bisphosphonates & 1 calcium/D3. 11 (34%) were osteopenic of which 1 was on Calcium/D3 and 10 had no treatment.

Although this is quite a labour intensive intervention, it did identify many untreated osteoporotic patients who were a high risk of future fracture. It also highlighted the small number of patients who are referred for Dexa or commenced on treatment by their GP following the fragility fracture. We would recommend this strategy to other units for case finding. This emphasizes the importance of a FLS and the need to have active ways to implement NICE guidance.