High prevalence of risk factors for low bone mineral density and estimated fracture and fall risk among elderly medical inpatients: a missed opportunity

Aims (1) To calculate the absolute fracture risk by using the fracture risk assessment (FRAX) model among elderly medical inpatients; (2) to assess the risk of falls, especially among patients with increased risk of fractures; and (3) to design and implement a bone health protocol to improve the assessment of fracture risk. Methods The study participants were all inpatients admitted to the medical wards at University Hospital Kerry, Ireland. All consecutive eligible patients aged >= 65 years were prospectively evaluated to populate clinical risk factor variables used in the FRAX model and the fall assessment was made by using Fracture Risk Questionnaire. Results Consecutive 465 medical inpatients were screened, and 200 eligible medical inpatients were evaluated. The mean age of the cohort was 73.8 +/- 9 years and 56% were male. The body mass index of the cohort was 27 +/- 5, and only 21% (n = 42) of patients reported having ever had a DXA scan. Previous personal history of low fragility fracture was present in 20.5% (n = 41) of the patients. The absolute 10-year risk of major osteoporotic and hip fracture was 15 +/- 12 and 7.6 +/- 11, respectively, and 25.5% (n = 51) and 64.5% (n = 129) respectively of the cohort had fracture risks exceeding the National Osteoporosis Federation (NOF) thresholds for treatment. High fall risk was noted in 63% of the cohort. Conclusions A very high prevalence of fracture and fall risk was noted. A medical inpatient stay offers a window of opportunity for assessment of osteoporotic fracture risk. With these findings, a bone health protocol has been developed.