Poster Presentation ESA-SRB-NZSE-CaSR 2026 in conjunction with ENSA

Inpatient DEXA in Older Adults with First Fragility Fractures: An Australian Cohort Study (#334)

Jeffrey Chandra 1 2 , Aisling Maher 3 , Mason Attfield 3 , Dujinthan Jayabalan 1 4 , Wendy Harrod 3 , Carla Davies 3 , Hannah Seymour 3 , Jonathan Beilin 2 3
  1. Medical School, University of Western Australia, Perth, WA, Australia
  2. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
  3. Fiona Stanley Hospital, Perth, Australia
  4. Sir Charles Gairdner Osborne Park Health Care Group, Geriatric, Acute and Rehabilitation Medicine, Perth, Western Australia, Australia

Background: Fragility fractures in older adults are associated with high risk of refracture and mortality. Despite guideline recommendations, inpatient bone-density assessment (DEXA) is often underutilised. DEXA T- score constitutes one of the necessary eligibility criteria for PBS reimbursement of osteoanabolic therapy in Australia. Registry data suggest fewer than 1 in 5 patients receive post-fracture DEXA or pharmacotherapy [1,2]. This study aimed to evaluate determinants and rates of inpatient DEXA in older patients with fractures.

Methods: Retrospective analysis of consecutive patients 65 years admitted with index fragility fracture to a secondary Orthopaedic Geriatrics Unit between January and April 2025. High imminent fracture risk was defined by hip or symptomatic vertebral fracture. Very High Risk was defined per Healthy Bones Australia[3]. Frailty was defined by Clinical Frailty Score 6.

Results: Eighty patients were included with median age 83.5 years (IQR 78.5 to 88.5), with 51 females (63.7%). Eighteen (22.5%) patients were considered frail, and 14 (17.5%) were nursing home residents. Of fifty-five patients with high imminent fracture risk, 16 (29.1%) were considered appropriate candidates for DEXA; with 3 (18.8%) receiving DEXA. Of patients considered not of high risk, 6 (24%) were assessed by DEXA, leading to significant difference in DEXA uptake by risk profile (p=0.023). In combined High or Very High risk criteria, 6 (37.5%) eligible patients received DEXA analysis. Overall, 71 of 80 (88.7%) patients did not undergo DEXA imaging, reflecting missed opportunities in eligible patients, limitations imposed by clinical frailty or residential status, and appropriate non-investigation of a low-risk population.

Conclusions: Inpatient DEXA is underutilised in older adults with fragility fractures. Although frailty and nursing home residency limit suitability for some patients, the majority of eligible high-risk patients did not undergo imaging. System level approaches, such as automatic referral or post-discharge liaison models, are needed to close the practice gap.

  1. Ross BJ, Lee OC, Harris MB, Dowd TC, Savoie FH 3rd, Sherman WF. Rates of osteoporosis management and secondary preventative treatment after primary fragility fractures. JB JS Open Access. 2021;6(2):e20.00142. doi:10.2106/JBJS.OA.20.00142
  2. Le HV, Van BW, Shahzad H, et al. Fracture liaison service, a multidisciplinary approach to osteoporosis management. Osteoporosis Int. 2024;35(10):1719-1727. doi:10.1007/s00198-024-07181-7
  3. Healthy Bones Australia. Summary Recommendations 2024. Published 2024. Accessed May 31, 2026. https://healthybonesaustralia.org.au/wp-content/uploads/2024/05/summary-recomendations-2024.pdf