Clinical audit suggestions: osteoporosis

Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Osteoporosis leads to nearly nine million fractures annually worldwide.

Pathway

National Institute for Health and Care Excellence (NICE) pathway for diagnosis, treatment and care of people with osteoporosis

Clinical knowledge summary

NICE clinical knowledge summary:Osteoporosis – prevention of fragility fractures

Audit criteria

Patients at increased risk of fragility fracture should have their fracture risk formally assessed with a validated tool such as NICE guidance on Osteoporosis: assessing the risk of fragility fractures.

Risk factors include:

• prior fragility fracture
• known low bone mineral density (BMD)
• body mass index (BMI) <19kg/m²
• parental history of hip fracture
• glucocorticoid use (any dose for ≥ three months)
• alcohol use ≥ three units daily
• rheumatoid arthritis
• housebound
• smoking
• secondary causes of osteoporosis – these include:
  
  • inflammatory bowel disease (e.g. Crohn's disease)
  • malabsorption (e.g. coeliac disease)
  • cystic fibrosis
  • hyperthyroidism
  • hyperparathyroidism
  • vitamin D insufficiency
  • immobilisation (e.g. resulting from CVA or Parkinson's disease)
  • chronic obstructive pulmonary disease
  • diabetes melitus type 1
  • chronic renal and hepatic disease.

Other audit and case-finding projects can be found at Osteoporosis Resources for Primary Care. This piece of work is the result of a joint initiative between the Royal College of General Practitioners and the National Osteoporosis Society. The aim of the project was to equip GPs, practice nurses and other members of the practice team with relevant information about osteoporosis in light of the inclusion of the condition in the Quality and Outcomes Framework.

Resources

Osteoporosis Case Finding in Primary Care (Patient.co.uk) – for Read codes and case-finding information

FRAX – 10-year fragility fracture risk, adjusted for RA

QFracture-2012 – 10-year fragility fracture risk, adjusted for RA

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