From the 2023 HVPA National Conference
Zhuo Yu DO (Stony Brook University Hospital), Lisa Fisher MD (Northport VA Medical Center), Jane Hand MD, Kathy Tin DO
In elderly patients, falls can be disabling and result in complications, including fractures, hematomas, immobility, and venous thromboembolism with prolonged bedrest. Patients with osteoporosis are at an especially high risk for fractures with falls and its complications. Although women are at a greater risk of developing osteoporosis with increasing age, men can also develop osteoporosis with aging. The National Osteoporosis Foundation recommends screening for osteoporosis in male patients ≥ 70 years old with dual energy x-ray absorptiometry (DEXA) scans. Studies have shown that men who meet age criteria are insufficiently screened for osteoporosis.
The purpose of this study is to determine and improve rates of osteoporosis screening in Northport Veteran Affairs male Veterans ≥ 70 years old as recommended by the National Osteoporosis Foundation.
Retrospective chart review of the resident primary care clinic from September 2019 through December 2019 showed that 717 male Veterans met age criteria, however only 9.76% were appropriately screened for osteoporosis. Of these Veterans, 14.29% were found to have osteoporosis and 58.57% were found to have osteopenia. Patients that were diagnosed with osteoporosis with DEXA scan were offered and initiated on appropriate treatment, including bisphosphonates, which have been shown to reduce fracture risk and improve mortality.
As intervention, resident physicians were subsequently educated on screening for and treatment of osteoporosis in a primary care setting. In addition, electronic reminder (as shown in supplement) for osteoporosis screening was developed and embedded in patient chart, which will show up at each patient visit.
Retrospective chart review of the resident primary care clinic after interventions from March 2021 through June 2021 showed 690 male Veterans who met age criteria of whom now 22% were appropriately screened for osteoporosis. Of these Veterans, 16.99% were found to have osteoporosis and 47.71% were found to have osteopenia. With our intervention, we were able to screen more than twice as many Veterans for osteoporosis (9.76% compared to 22% pre- and post-intervention, respectively); but there is still more screening that could be done.
Screening for osteoporosis could easily be overlooked when seeing male patients during a primary care visit. Our project indicates that simple interventions with the use of technology can help educate clinicians regarding osteoporosis screening recommendation, which transfers to increase in screening rate among our VA patient population and start treatment if appropriate to prevent future complications.
We discovered that our Veterans have a high rate of osteopenia, which provides a target population for us to educate on the importance of bone health and fall prevention during each primary care visit. Thus, it is essential to continue resident education and improve rates of osteoporosis screening and treatment in the hopes of preventing complications in male Veterans.