Fracture prevention: a population-based intervention delivered in primary care

Area of Science:

• Gerontology and Public Health
• Pharmacology and Therapeutics

Background:

• Osteoporosis is a prevalent condition, particularly in aging populations, significantly increasing fracture risk.
• Effective pharmacological interventions are available but often underutilized.

Purpose of the Study:

• To evaluate the implementation of proactive fracture risk assessment using FRAX (Fracture Risk Assessment Tool) and optimize treatment for high-risk individuals in primary care settings.
• To identify gaps in osteoporosis diagnosis and treatment within the National Health Service (NHS).

Main Methods:

• A clinical cohort study was conducted across 71 primary care practices in two NHS Clinical Commissioning Group areas between November 2017 and November 2018.
• Fracture Risk Assessment (FRAX) was applied to specific age and risk factor groups according to NICE CG146 guidelines.
• Data analysis focused on osteoporosis diagnosis rates, prescription patterns of bone sparing agents (BSAs), and treatment duration.

Main Results:

• Out of 158,946 individuals meeting NICE CG146 criteria, 7.5% had an osteoporosis diagnosis, with only 42% prescribed a BSA.
• Thirty percent of untreated patients with osteoporosis had never received a BSA, and 35% of those prescribed BSAs received them for less than the recommended duration.
• Among patients meeting the FRAX treatment threshold, 37% had no history of BSA use, and the projected 3-year fracture incidence from untreated patients was 875, with an estimated cost of £3.4 million.

Conclusions:

• The study identified significant underdiagnosis and suboptimal treatment of osteoporosis in primary care.
• Implementing NICE guidelines for fracture risk assessment and optimizing BSA treatment is feasible and can lead to substantial fracture prevention and cost savings.