Abstract
1. Introduction
At Wrightington, Wigan and Leigh 412 patients were admitted with hip fracture diagnoses in 2024. As part of the orthogeriatric review, bone health medications zoledronic acid and denosumab were utilised in this cohort of patients, where appropriate, to address the significant risk of “imminent fracture” in line with NOGG guidelines. The aim was to review January to June of 2024; 118 patients were evaluated, reviewing delays in initiation of these treatments to improve services and patient care.
2. Method
Utilising hospital electronic records, a sample of patients were selected from those admitted in 2024 (118 patients). These were split into treatment choices zoledronic acid (59 patients) and denosumab (59 patients) to better evaluate the pathways for each treatment. An intervention to consent and initiate treatments before discharge in patients presenting with a hip fracture was implemented at WWL in September 2023. The results reviewed the number of patients receiving treatments before discharge, the date range variation between first doses and why these were so varied.
3. Results
The average length of time for first dose denosumab was 62 days, improved greatly since 2022 (187 days) and 2023 (76 days). The average length of time for first dose zoledronate was 72 days with no comparative data. Further analysis shows how zoledronate delays in 91% of patients was due to the practice of not administering bisphosphonate medications within 14 days of surgery, a practice that has now changed. Furthermore, 64% of denosumab patients and 75% of zoledronate patients were delayed due to replacement of vitamin D.
4. Conclusion(s).
Implementation of inpatient consent has been shown to expediate first dose denosumab greatly. Analysis of data will be required to review the first dose administration of zoledronate; stopping limitations such an administering within the 14 days of surgery should reduce delays further.