Closing the Gap in Osteoporosis Risk Assessment for Smokers and High-Risk Alcohol Users in a General Practitioner (GP) Practice

Objective This quality improvement project (QIP) aimed to enhance the identification, management, and documentation of osteoporosis risk among patients aged 50 and above who are both smokers and high-risk alcohol consumers (>14 units/week) in a GP practice. Methods The project was conducted over three cycles using the Plan-Do-Study-Act (PDSA) framework. Eligible patients were identified via systematic electronic health record (SystmOne) searches. Interventions included systematic FRAX (Fracture Risk Assessment Tool) scoring for identified high-risk patients, patient contact through text or telephone for those needing further assessment, involvement of practice pharmacist and risk assessment follow-ups, and embedding a FRAX electronic prompt into routine checks at the end. Outcomes measured were FRAX documentation rates, recorded dual-energy X-ray absorptiometry (DXA) result rates, and documentation of appropriate management of DXA results. We assessed statistical significance using Fisher's exact test. Results A total of 49 patients who smoked and consumed alcohol at high-risk levels met the inclusion criteria. At baseline, only one out of 49 eligible patients (2.05%) had a recorded FRAX score. Following three PDSA cycles, FRAX documentation increased to 50 out of 50 patients (100%) (p<0.001), with one additional patient meeting the inclusion criteria during the course of the project. Of 22 patients requiring DXA, only two (9.09%) had scans at baseline, which increased to 11 (50%) following interventions (p=0.0068). Two (22.2%) of nine patients who needed and had a DXA scan for assessment after interventions had osteoporosis, five (55.6%) osteopenia, and two (22.2%) normal bone density. Interventions were initiated following the National Osteoporosis Guideline Group (NOGG) guidelines. Conclusions This quality improvement initiative showed that systematic changes can improve adherence to osteoporosis prevention measures within a primary care setting. Electronic health record searches and involvement of a multidisciplinary team enabled improvements in both the identification of high-risk patients and their clinical management. However, the single-site setting, limited cohort size, and short follow-up period, as well as dependency on accurate electronic documentation, restrict generalisability. Targeted QI interventions can cause substantial improvements in fragility fracture risk assessment and DXA scanning and preventive measures in high-risk groups within primary care. Embedding prompts in electronic health systems and involving multidisciplinary team members are practical strategies to increase fracture prevention. Future expansion to other risk groups and evaluation of long-term outcomes will be essential to facilitate further improvement in the prevention of fragility fractures.