1014 OPTIMISING BONE HEALTH IN FRAIL OLDER ADULTS: IS INTRAVENOUS BISPHOSPHONATE THERAPY DURING ACUTE ADMISSION WARRANTED?

Abstract Introduction Recommendations on bisphosphonates focus on 10-year risk of osteoporotic fracture. Evidence in frail older adults is limited. The HORIZON Pivotal Fracture trial1 included patients aged ≥80 years and showed a relative risk reduction of 60% for vertebral fractures at 1 year. Patients admitted with a fall should undergo bone health assessment, and if at moderate/high risk should be considered for treatment or referral to metabolic bone clinic (MBC). Oral bisphosphonates are poorly tolerated in older adults due to side effects and compliance2. Anecdotal evidence suggests high rates of non-attendance at MBC. We reviewed outcomes in patients admitted following a fall to review whether inpatient zoledronate during acute admission should be considered. Method 100 patients admitted to Sheffield Frailty Unit between 1/10/19–12/11/19 presenting with a fall were identified. Data was collected from electronic records and physical notes. Basic statistical analysis was performed. Results There was a female preponderance (60%), a mean age of 86.7 years and a median clinical frailty score (CFS) of 6. 26% of patients had no recorded bone health assessment. 32% required no further action, either scoring low-risk or already on treatment. 12% of cases had active decisions against therapy. 30% scored moderate or high risk. Of these, 11 patients started bisphosphonates and 4 had plans for GP review on discharge. 15 patients were referred to MBC but only one-third attended, due to a combination of missed referrals, cancelled appointments, or ‘did not attend’. 59% were readmitted with further falls over the next 18 months. 39% of patients died within 12 months. Conclusion Patients with a CFS of 6 or chronic cognitive impairment could be considered as candidates for inpatient intravenous bisphosphonate therapy. Factors to consider include ability and desire to attend outpatient appointments, compliance and tolerance of oral therapy and the overall functional status and prognosis.