Management of patients admitted to hospital with acute vertebral fragility fractures: a modified Delphi study

Introduction Acute vertebral fragility fracture requiring hospital admission is common, painful and disabling. No comprehensive clinical guideline for their care exists. To support the development of such a guideline, we sought the views of experts in the field. Methods A modified Delphi study was used. A total of 70 statements were presented, using an online platform, over three consensus-seeking rounds, to participants with experience in the hospital care of patients with acute vertebral fragility fractures from UK-based specialist societies. Participants rated the level of their agreement with each statement on a 5-point Likert scale. Consensus was defined at 70% of respondents choosing either agree/strongly agree or disagree/strong disagree. Over the first two rounds, statements not reaching consensus were modified in subsequent rounds, and new statements proposed by participants and agreed by the research team could be added. Results There were 71 participants in the first round, 37 in the second round and 28 (most of whom were geriatricians) in the third round. Consensus was reached in 52 statements covering fracture diagnosis, second-line imaging, organisation of hospital care, pain management and falls and bone health assessment. Consensus was not achieved for whether vertebral fragility fractures should be managed in a specific clinical area. Discussion These findings provide the basis for the development of clinical guidelines and quality improvement initiatives. They also help to justify research into the merits of managing acute vertebral fragility fracture patients in a specific clinical area.

The presentation of older people with vertebral fragility fractures to a university hospital: a cross-sectional analysis

Introduction: There is a lack of robust data on hospitalised acute vertebral fragility fractures. This analysis aimed to report on the number of hospitalised vertebral fragility fractures treated in a large UK teaching hospital. This information would support better design of hospital services and resource allocation to manage this group of patients. Method: Patients aged 50 years and over hospitalised with a vertebral fragility fracture from 1/2/2016 to 31/1/2017 were identified from radiology and hospital records. Patients sustaining vertebral fractures due to either major trauma or malignancy were excluded. Data was collected on patient demographics, fracture details, hospitalisation details and health outcomes. Results: 208 patients with acute vertebral fragility fractures were hospitalised over a 12 month period. The mean(SD) age was 80.5(11) years, of which 68% were female. 94% presented to the Emergency Department (ED) as their first point of contact of which 70% were subsequently hospitalised. Two-thirds presented with a single level vertebral fracture predominantly around the thoracolumbar region. The majority (87%) were non-operatively managed by general physicians of which most were under Geriatric Medicine. The median length of stay was 12 (IQR 6-20) days and in-patient mortality was 3%. 52% of patients went on to have a bone health assessment. Conclusion: We have reported on the number of patients presenting to hospital with an acute vertebral fragility fracture over 12 months. This helps identify resources needed to design hospital services to manage them adequately.