Giustino Albanese (University of Wisconsin School of Medicine and Public Health), Miranda Bice (University of Wisconsin School of Medicine and Public Health), Paul Anderson (University of Wisconsin School of Medicine and Public Health), Kristyn Hare (University of Wisconsin School of Medicine and Public Health), Andrew Ross (University of Wisconsin School of Medicine and Public Health)
Patients treated with vertebroplasty for osteoporotic vertebral compression fractures benefit from secondary fracture prevention but may not be referred for treatment. A dedicated referral pathway for such patients during the interventional radiology clinic intake process may increase the likelihood of them receiving osteoporosis treatment and reduce secondary fracture risk.
To determine if providing a dedicated referral pathway for patients seen for vertebroplasty would increase the number of patients receiving secondary fracture prevention treatments after suffering an osteoporotic vertebral compression fracture.
The orthopedic surgery department at our institution hired a dedicated physician assistant—known as the fracture liaison–to provide initial evaluation and treatment of osteoporosis for patients who had suffered fragility fractures of any kind. The musculoskeletal interventional radiology service partnered with orthopedic surgery to provide a referral to the fracture liaison clinic for patients seen for vertebroplasty during their intake clinic visit. This retrospective, IRB approved study evaluated a total of 63 consecutive patients referred for vertebroplasty between 8/1/2016 and 1/5/2018, including 26 patients prior to the advent of the fracture liaison referral service and 37 patients post. In addition to demographic data, the health record was reviewed to determine if patients were being treated for low bone density prior to vertebroplasty and for those patients who were not already being treated, whether they were started on treatment for low bone density within 6 months following the vertebroplasty procedure.
Overall, approximately one third of patients were not already being treated for osteoporosis. Of these patients, prior to the referral program 17% were started on treatment for low bone density within 6 months of their vertebroplasty procedure. After the referral program, this increased to 55% of eligible patients (p=0.129).
A multi-disciplinary referral pathway may increase the number of patients being treated for vertebroplasty who receive secondary fracture prevention treatment after their procedure. However, referral may not always occur even when indicated. Moving forward, the referral process has been made “opt-out” instead of “opt-in” for the interventional radiology provider and communication between interventional radiology support staff and the fracture liaison service has been increased to make sure eligible patients don’t fall through the cracks. We will continue to monitor referral and treatment rates to assess the further success of these additional interventions.
Implications for the Patient
A dedicated referral pathway for vertebroplasty patients who are not already being treated for osteoporosis increases the likelihood that they will receive appropriate secondary fracture prevention interventions following vertebroplasty treatment and by extension, may decrease their risk of suffering a recurrent compression fracture.