MRS BAD BONES: Service Evaluation of Osteoporosis Secondary Prevention in Hip Fragility Fractures during COVID-19 Pandemic

BACKGROUND: Management of osteoporosis is an important consideration for neck of femur fracture patients due to the morbidity and mortality it poses Orthogeriatric teams input is invaluable in coordinating secondary fragility fracture prevention The COVID-19 pandemic resulted in the rapid restructuring of healthcare teams and led to the redeployment of the orthogeriatricians OBJECTIVE: This study aimed to determine the impact coronavirus disease 2019 (COVID-19) had on secondary prevention of fragility fractures in neck of femur fracture patients, and to optimise management in this population METHODS: A retrospective audit in neck of femur fracture patients pre- and post- UK lockdown in response to the COVID-19 pandemic A re-audit was conducted following the development of our new mnemonic, which addressed key factors in assessment and management of osteoporosis: Medication Review Rheumatology / Renal Advice Smoking Cessation Blood tests Alcohol limits DEXA scan Bone-sparing medications Orthogeriatric review Nutrition Exercise Supplements Fisher's exact test was used for comparison analyses between each phase RESULTS: Data for 50 patients was available in each phase The orthogeriatric team reviewed 88% of patients pre-lockdown falling to 0% due to redeployment, before recovering to 38% in the post-intervention period Lockdown brought a significant drop in prescription of vitamin D/calcium supplements from 81 6% to 58 0% (P=0 016);of bone-sparing medications from 60 7% to 18 2% (P=0 004), and DEXA scan requests from 40 1% to 3 6% (p=0 003) Following the implementation of our mnemonic, there was a significant increase in prescription of vitamin D/calcium supplements to 85 7% (P=0 003), bone-sparing medications to 72 4% (P=0 0002) and DEXA scan requests to 60% (P<0 0001) CONCLUSIONS: The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted on secondary prevention of fragility fractures in this population The 'MRS BAD BONES' mnemonic significantly improved the management and could be used in a wider setting