Does a lack of physician awareness underlie the fragility fracture prevention care gap?

This research by Ghorani, Rajagopal and Suresh looks at how well the recently updated national guidelines for assessment of osteoporosis and risk of falls in the UK are being implemented.

Introduction: National guidelines for the prevention of osteoporotic fractures (OPFs) have recently been updated with clinical risk assessment algorithms such as the WHO fracture risk assessment tool (FRAX). However, national audit evidence suggests suboptimal rates of risk assessment and under-utilisation of anti-osteoporotic agents (AOPs) for at risk patients (Royal College of Physicians 2010). We set out to investigate whether this care gap persists and hypothesise that a lack of physician awareness underlies it.

Physicians ranging from FY1 to consultant grade (n = 24) were randomly selected for assessment of their awareness concerning developments in OPF prevention. A hypothetical case of an at risk patient was presented and participants asked whether, 1. They would commence an AOP, and 2. They are aware of FRAX.

Results: Of patients not on an AOP (n = 22/37; 59.5%), in total half were in the high (n = 7/22; 31.2%; mean FRAX = 37.7%) and medium (n = 4/22; 18.2%; mean FRAX = 25.5%) risk categories, mandating treatment and evaluation of bone mineral density respectively.

Whilst 45.8% of physicians interviewed (n = 11/24) had heard of FRAX, only 1/24 suggested using it to guide management in this case.

Conclusions: Despite recently published guidelines, a significant number of patients at risk of OPF are missing screening opportunities, suggesting a need for routine assessment which we are currently trialling. The finding that a majority of hospital doctors are unaware of the use of FRAX in risk assessment suggests an underlying cause for the identified care gap and a need for greater focus on educational interventions.

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