Aims: Secondary prevention in patients suffering neck of femur fractures is an effective but under utilised strategy in reducing subsequent fragility fractures. Published BOA guidelines recommend patients aged 75 or over with fragility fractures should receive bisphosphonates, falls risk assessment, and vitamin D supplements if there are concerns regarding deficiency. This audit aimed to determine the effectiveness of implementing secondary prevention strategies in patients admitted with neck of femur fractures.

Methods: Patients aged 75 or above admitted to a local trauma unit with neck of femur fractures were identified over a two-year period. In-hospital mortality was recorded. Discharge letters for the remaining patients were obtained. Data was collected on whether patients were commenced on bisphosphonates and vitamin D supplements in hospital, or whether advice was given for these therapies to be initiated in the community. Patients undergoing falls risk assessment prior to discharge were also noted.

Results: Overall 549 patients met the inclusion criteria. Eighty patients died during admission giving an in-hospital mortality rate of 14.6% per year. A further 238 patients were excluded due to missing data leaving 231 patients in the final study population. Mean age was 84.4 yr (range 75–97 yr) and 77.9% (n=180) were female. Bisphosphonate therapy was commenced or recommended in 22.9% (n=53), vitamin D supplements in 46.3% (n=107), and 16.5% (n=38) underwent falls risk assessment. Only 4.3% (n=10) were commenced on bisphosphonates and underwent falls risk assessment.

Conclusions: Despite evidence that secondary prevention is effective in reducing subsequent fragility fractures our findings demonstrate these strategies are poorly implemented with less than one in twenty patients receiving the recommended falls assessment and antiresorptive therapy. A standardised discharge letter for patients with neck of femur fractures would provide more effective communication between hospitals and primary care thereby assisting the implementation of secondary prevention strategies.