JMIR Publications

ABSTRACT

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 explored the impact COVID-19 had on secondary prevention of neck of femur fragility fractures, and potential interventions to improve assessment and management.

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 implementation of our new mnemonic ‘MRS BAD BONES’: Medication Review Rheumatology / Renal Advice Smoking Cessation Blood tests Alcohol limits DEXA scan Bone-sparing medications Orthogeriatric review Nutrition Exercise Supplements

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=0.0156); of bone-sparing medications from 60.7% to 18.2% (P=0.0037), and DEXA scan requests from 40.1% to 3.6% (p=0.0027). Following the implementation of our mnemonic, there was a significant increase in prescription of vitamin D/calcium supplements to 85.7% (P=0.0034), bone-sparing medications to 72.4% (P=0.0002) and DEXA scan requests to 60% (P<0.0001).

Conclusions:

COVID-19 had a major impact on the 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.