National hip fracture database preliminary national report. Effective treatments for osteoporosis exist and the british orthopaedic association boa has guidelines governing how to manage underlying osteoporosis in patients with fragility fractures. Together with the webbased national hip fracture database, the blue book offers guidance. Jul 21, 2016 the scottish hip fracture audit lit the path. Effect of national guidelines on rates of hip fracture, nonhip fracture. The pbr guidance and boa bgs blue book provides detailed background information on the fragility hip fracture bpt but the following provides a brief summary. The blue book of the british orthopaedic association 2007 stated that hip fractures should be operated on within 48 hours. Boa standards for trauma and orthopaedics boasts the boasts are short standards documents that currently are traumarelated and produced by the boa s trauma group. The boa standards for trauma boast guidelines are extremely useful when preparing for st3 trauma and orthopaedic interviews. Patient outcomes were compared with the standards from our orthopaedic working group and those from the british orthopaedic association that.
Since 2007 the national hip fracture database nhfd has. With the beast from the east bringing us in line with our scandinavian neighbours who have the highest incidence of hip fractures in the world, what will be. Pdf how well are we managing fragility hip fractures. British orthopaedic association british geriatric association blue book standards 1 all patients with hip fractures should be admitted to an acute orthopaedic ward within 4 hours of presentation. Reduced quality of life, pain and disability may result from all fragility fractures.
Guidelines to compliment the integrated care pathway for. In 2007, the british orthopaedic association boa and british geriatrics society bgs published the blue book, the care of patients with fragility fractures, which describes six quality care standards derived from evidencebased clinical practice. In setting up a disease registry for fragility fractures in hong kong, we conducted a retrospective systematic study on the management of fragility hip fractures. The blue book highlights the need for consistent delivery of nhfd standards 5 and 61,2. Fragility fracture clinic these fractures can dramatically change the quality of life for patients and their families due to a loss of patient independence, significant disability and even death. Boast guidelines summary st3 orthopaedic interview. This was followed by the development of the national hip fracture. The national hip fracture database nhfd is a nationwide audit within the nhs concerning the management and outcomes of patients with hip fractures it was initially set up by the british orthopaedic association and the british geriatrics society, however it is now commissioned by the healthcare quality improvement partnership hqip, a consortium of the academy of medical royal. The british orthopaedic association boa is the surgical specialty association for trauma and orthopaedics in the uk. Hip fractures in elderly patients represent a health issue of global proportions. The boa blue book1 provided guidance on secondary prevention of fragility fractures.
They are downloadable from our website and can be printed for display in hospitals. The role of gps in the management of osteoporosis is crucial. Hip fractures are the most common cause of injury related death in the uk. Sep 19, 2014 the publication of the boa bgs jointly sponsored blue book, providing guidelines to the care of patients with fragility fractures in 2005 the national hip fracture database nhfd. The aim is to promote multidisciplinary rehabilitation services and secondary prevention of hip fractures. Orthogeriatrics in the management of frail older patients. A comprehensive service should consist of osteoporosis assessment, including a dualenergy xray absorptiometry dxa scan to measure bone density, if appropriate, treatment with bone protection therapy in osteoporosis patients, falls risk assessment and. The guidelines available on below are those for which the boa is not the sole.
Falls and fallrelated injuries are a frequent and serious problem for older people. The care of patients with fragility fracture blue book osteoporosis. The momentum continued with the creation of the national hip fracture. To improve the quality of life in elderly people with. Secondary prevention of osteoporosis in nonneck of femur. Around 25% of the deaths following hip fractures are related directly or indirectly to the fracture, and around 75% to comorbidities kanis, 2003. The british orthopaedic association boa published the blue book september 2003, updated 2007 the care of patients with fragility fractures and suggests the following components to prevention. Boast 1 patients sustaining a fragility hip fracture. To maintain a fragility hip fracture registry, the national hip fracture database united kingdom and boa bgs blue book were taken as standards and modified for indian setup. Boa associated guidelines british orthopaedic association. The british orthopaedic association published its blue book with guidelines for orthopaedic surgeons for secondary prevention of fragility fracture in september 2003. For patients admitted with a fragility fracture of the hip, there remains wide variation. Considering similar findings to this study, the british orthopaedic association boa in 2007 has published a blue book on the care of patients with fragility fractures in consultation with.
Best practice for patients with hip fracture oxford. The most common fragility fractures occur in the spine, wrist, and hip. Having had one fragility fracture is a significant risk factor for having another. Osteoporosis prevention of fragility fractures nice cks. Jun 27, 2009 the most common fragility fractures occur in the spine, wrist, and hip. The boa blue book 1 provided guidance on secondary prevention of fragility fractures. A comprehensive service should consist of osteoporosis assessment including a dual energy xray absorptiometry dxa scan to measure bone density if. This edition of the blue book is sponsored by the british orthopaedic association and the british geriatrics society and seeks to summarise current best practice in the care and secondary prevention of fragility fractures. Optimum care of patients with hip fracture is complex and involves many. Fragility hip fractures in elderly patients in bhubaneswar.
Osteoporosis and fragility fractures throughout the life course boa bgs blue book 2007 adapted from j endo investigation 1999. Care of patients with fragility fracture blue book. Osteoporosis, falls, fractures and the fracture screening. For each standard deviation decrease of a measure at the distal radius, the odds ratio for fragility fracture was 2. Osteoporosis, falls, fractures and the fracture screening and. This has been complemented by the british orthopaedic association boa standards for trauma care for hip fracture boast 1 which synthesise the relevant guidance from the national institute for health and care excellence nice and the boa bgs blue book on hip fracture management 1, 2. Trauma and orthopaedic surgery can not only help people stay active for longer by increasing mobility, but also help enable people to return to work, and live more independently.
Published by the british orthopaedic association september 2007. The mean age of patients with fragility hip fracture in our 2012 data was 82. National hip fracture database preliminary national report 2009. This revised edition of the blue book is sponsored by the british orthopaedic association and the british geriatrics society and seeks to summarise current best practice in the care and secondary prevention of fragility fractures. The boa blue book in 2007 outlined the key standards for the care of hip. Management of distal radial fractures the british society.
Patient outcomes were compared with the standards from our orthopaedic working group and those from the british orthopaedic association that runs a mature fracture registry in the united kingdom. These guidelines have been produced in collaboration between the boa and bssh and complement the boast on drfs. Fragility fracture clinic orthopaedic surgery michigan. Fragility fractures are caused by weak bones, and occur when you fall from a standing height or less, says orthopedic surgeon faisal mirza, md, of good samaritan hospital. Blue book chapter 1 effective orthogeriatric services for hip fracture patients universal national hip fracture database participation hip fracture prevention blue book chapter 2 an fls for every hospital to identify all new fragility fracture patients. Approximately 300,000 fragility fractures occur each year in the uk. Orthogeriatric medicine and fracture liaison going from. Complications of osteoporosis are fragility fractures and their consequences.
Good practices guides focus on providing information on a clinical topic. The national hip fracture database nhfd is a nationwide audit within the nhs concerning the management and outcomes of patients with hip fractures it was initially set up by the british orthopaedic association and the british geriatrics society, however it is now commissioned by the healthcare quality improvement partnership hqip, a consortium of the academy of medical royal colleges and. The prince of wales british orthopaedic association 3543 lincolns inn fields london wc2a 3pe tel. Thecareofpatientswith fragilityfracture published by the british orthopaedic association september 2007 fragility blue book 12907 17. The bpt for fragility hip fractures, was developed to encourage two key clinical characteristics of best practice. Over 70,000 hip fractures occur annually in the uk. Blue book on the management of distal radial fractures. In recent years 3 major documents, the evidencebased nice guideline 21, 12 the nsf for older people standard 6 26 and the recently published joint guidelines by the british orthopaedic association boa and the british geriatric society bgs, the care of patients with fragility fracture the blue book 3 have defined the service standards. Also, women with fractures had lower failure load 10% with higher total area and trabecular area than women without fractures. This allows care to be benchmarked according to evidencebased standards in the boa bgs blue book on the care of patients with fragility fractures 27. Britishorthopaedicassociation british geriatrics society. The management of patients with distal radial fractures remains controversial. Boa associated guidelines the guidelines available on below are those for which the boa is not the sole author but has collaborated with other specialty associations or specialist societies. There are many studies that have analysed specific sections of the management of drfs but there is a need for a guide to summarise the treatment options.
Fragility fractures and their care are a challenge to our health care system. Boa bgs blue book 2007 executive summary general this revised edition of the blue book is sponsored by the british orthopaedic association and the british geriatrics society and seeks to summarise current best practice in the care and secondary prevention of fragility fractures. Guidelines to compliment the integrated care pathway for hip. Mar 02, 2016 this has been complemented by the british orthopaedic association boa standards for trauma care for hip fracture boast 1 which synthesise the relevant guidance from the national institute for health and care excellence nice and the boa bgs blue book on hip fracture management 1, 2. The following list shows the six standards monitored by nhfd. Now a new collaboration between the british orthopaedic association boa and the british geriatrics association bgs has led to another major initiative, signalled by the simultaneous launch in september of a new boa bgs blue book on the care of patients with fragility fracture 10 and the national hip fracture database nhfd.
About 50% of people with an osteoporotic fragility fracture of the hip can no longer live independently. The following is taken from the blue books executive summary. Care of patients with fragility fracture blue book british geriatrics. Fracture surgery aagbi, boa, bgs distal radial fracture blue book boa.
Fragility hip fractures in elderly patients in bhubaneswar, india 2012 2014. Guidelines to compliment the integrated care pathway for hip fracture. Managing osteoporosis in patients with fragility fractures. There are three fracture sites said to be typical of fragility fractures. However, all bones are susceptible to this type of fracture, so take steps to prevent these from happening to you, by having.
This document summarised evidencebased standards for older patients with fragility fractures, including the need for an orthogeriatric model of care. The national clinical audit of falls and bone health. Fragility fracture is a type of pathologic fracture that occurs as result of an injury that would be insufficient to cause fracture in a normal bone. Thats why the university of michigan established the fragility fracture clinic. Best practice tariff bpt for fragility hip fracture care. The evidencebase for hip fracture care is improving rapidly and. A prospective multicenter study of 1031 elderly patients. Please note you can also search for published documents in our knowledge hub. The 2007 british orthopaedic association and british geriatrics society boa bgs guideline on the care of patients with fragility fracturethe boa bgs blue book 1 is a collaborative effort, with input from other groups, including the primary and secondary care forums of the national osteoporosis society. Feb 15, 2017 vertebral fractures can cause longlasting pain and disability as described above and are also associated with a reduced life expectancy.
The publication of the boa bgs jointly sponsored blue book, providing guidelines to the care of patients with fragility fractures in 2005 the national hip fracture database nhfd. The nhfd was launched in 2007 alongside the care of patients with fragility fracture ie, the blue book, also a boa bgs collaboration, with the nhfd monitoring compliance with the six consensusderived clinical standards for hip fracture care set out in the blue book. It is vital to know each in detail and how to apply these in an orthopaedic interview clinical case. It allows care to be audited against the six evidencebased standards set out in the boabgs blue book on the care of patients with fragility fracture. The incidence of fragility fractures could double in the next 50 years. The most common fragility fractures are those of the proximal femur hip, vertebrae spine, and distal forearm wrist.
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