Introduction:
While there are growing numbers of interventions available to prevent, diagnose, and treat osteoporosis, few patients with fractures and osteoporosis receive those interventions. Fractures increase disability and the possibility for death, as well as create an economic burden for the patient, health system and society. Therefore, effective diagnosis and treatment of osteoporosis will aid in future fracture reduction.
Problem:
The Metabolic Bone Team (MBT) at Lehigh Valley Hospital identified a potential problem with under diagnosis and treatment of osteoporosis following fragility and pathologic fractures based on lower than expected MBT consultations and DXA scans ordered.
Methodology 1:
The hospital's clinical database was queried to determine the total number of patients at high risk following a low trauma fracture and pathologic fracture as well as to determine diagnosis and treatment patterns for osteoporosis. Patient data from FY 2002 included 1,084 patients with pathologic or low trauma fractures of the pelvis, femur, distal humerus, vertebra, clavicle, radius or ulna.
The largest sub-population, 275 femur fractures, was examined. Collected for each patient were: all diagnosis codes, demographics, variable costs, osteoporosis medications, multivitamin, calcium and vitamin D supplements, length of stay, DRG, admit type, admit source, height, weight, BMI, fall from information, accident location, attending physician, consults, bone density test dates and discharge disposition. Through chart review, 14 patients were excluded due to traumatic falls.
Results:
From the remaining 261 patients, 61 patients had documented osteoporosis. The majority of the patients, 202 (77.4%), came from home and admitted through the emergency department. Of the 261 patients, 79% were female, the average age was 82, seven had documented bone density scan within two years of their admission and 25 patients had previous fractures causing hospitalization. Five were discharged home, eight died, and 80% went to skilled nursing facilities. Approximately 47% were taking supplements including multivitamins, calcium and vitamin D. Only 7% were receiving osteoporosis medications. All those receiving osteoporosis medications had a documented diagnosis of osteoporosis.
Methodology 2:
A community screening and education program was also implemented with lectures and complimentary heel screenings available 12 hours in the Center for Healthy Aging, at businesses and organizations, and at health fairs.
Results 2:
In 12 months, 1002 individuals (average age - 57) were screened using a heel bone density scanner. Letters are sent to primary care physicians for those having T-scores -1.5 or below requesting they order a DXA for their patient. Approximately 19% (average age - 63) were referred for DXA; however only 19% of those referred have completed their DXA exam. When queried as to why the participants did not follow-up, many stated they did not think that finding out if they have osteoporosis was important or that their primary care physician did not order the test.
Conclusion:
Based upon the findings of the inpatient hip fracture study and the lack of referrals for DXA following a positive screening, it is clear that practitioner attitudes and behaviors must be changed regarding the morbidity of osteoporosis and the importance of early diagnosis and treatment.
Disclosure Information:
Faculty Member's Name: Sallie J. Urffer, LPTA, MHA
I have no relationships to disclose.
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