Aim: To identify barriers to anti-resorptive therapy initiation following neck of femur fractures and implement quality improvement interventions.
Methods: A retrospective descriptive analysis was conducted on patients in the NOF fracture registry in 2024. Data were collected using an Advanced-Trainee-designed assessment protocol.
Results: Of 116 patients (median age 81 years, mode Clinical Frailty Scale score 5, 84% Caucasian, 84% lived at home, 66% with baseline cognitive impairment) most patients (95%) underwent surgery. Median acute hospital length of stay was 12 days. Overall mortality was 4.3% (40% in aged care residents), and 8% transitioned to residential care. 85% of patients were anti-resorptive therapy-naïve, and among this group, 69% missed treatment before discharge. Of those not commenced on therapy, 44% had appropriate reasons (death, palliative approach, required renal or endocrinology follow-up, dental clearance, another hospital transfer, or NOF being not considered), while 56% missed their anti-resorptive treatment inappropriately (requested outpatient DEXA scan (n=5), awaiting Vitamin D results without loading (n=16), or no clear reasons (n=17)), despite being reviewed and recommended for anti-resorptive therapy by Ortho-Geriatric or Perioperative team.
Conclusion: This audit identified system-level gaps in secondary fracture prevention following NOF fractures. These findings support the urgent need for standardised hospital guidelines (emphasised on approaches to vitamin D replacement, dental clearance, identification of responsible clinicians, and community follow-up) alongside medical staff education and patient empowerment initiatives, to align with Hip Fracture Clinical Care Standards.