Barriers in Osteoporosis Diagnosis and Treatment

From the 2023 HVPA National Conference

Irvind Buttar DO (Lenox Hill Hospital), Michael Bonafede DO, Akshay Syal MD, Ethan Fried MD

Introduction:
Per the United States Office of Disease Prevention and Health Promotion, an estimated 10 million people age 50 years and above have osteoporosis. Osteoporosis is diagnosed by DEXA scans (1). If not identified or if left untreated, osteoporosis can lead to severe bone fractures and most commonly spine and hip bone fractures (2). We sought out to identify barriers and areas for improvement in our resident primary care clinic in diagnosing and treating osteoporosis.

Methods:
Charts were accessed for patients above the age of 65 who met indications for and were ordered for a DEXA scan in the 6 month time period of 1/1/22-07/1/22 at Lenox Hill Medicine Clinic. This search yielded 79 patient charts. By accessing these charts, we were able to identify how many patients completed their DEXA scan, and how many of these scans identified either normal bone density, osteopenia, or osteoporosis. We also were able to see how many patients diagnosed with osteoporosis were on treatment.

Results:  
There were 79 patient charts that met the following criteria: above age 65 with a DEXA scan ordered between 1/1/22-7/1/22. Out of the patients given DEXA scan orders, 34 (43%) patients completed the DEXA scan. Out of the 34 patients who got their DEXA scans done, 10 (29%) had normal bone density, 9 (26%) have osteopenia, 9 (26%) have osteoporosis and are on pharmacological treatment, 6 (17%) have osteoporosis not on pharmacological treatment.

Discussion:
By identifying and using pharmacological treatment, the fracture risk in patients with osteoporosis can be reduced by up to 50%. Therefore, it is imperative to diagnose the condition using a DEXA scan as early as clinically indicated. Our data above reveals that more than 50% of our patients who were ordered for DEXA scans never received their imaging. While the exact etiology to this gap in patient care is not yet defined, there are several possibilities. This includes lack of patient education, which can be bridged with a standard of practice in our clinic to explain the patient’s diagnosis, risk/benefit profile of DEXA scans, and its inherent necessity to treatment. To address this systemically, our current plan of action is creating a fact sheet on osteoporosis that patients will receive with their DEXA scan orders that reiterates the importance and necessity of the scan. After 6 months of fact sheet implementation, we plan to reassess the success in rates of completing the imaging. For the patients with an established osteoporosis diagnosis, the majority at the clinic are on pharmacological treatment. Of note, several other barriers besides education may play a role in patients not receiving their imaging, including insurance coverage, location inconvenience, or time restrictions. Through initiating our fact sheet method and aiming to pre-screen a patient’s willingness to receive their scan prior to ordering imaging, we hope to elucidate the cause in the gap between ordering and completing DEXA scans, and thereby improve our diagnostic ability through increased follow-up with DEXA scans.

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