The Value of Osteoporosis Screening: The Experience of an Academic Internal Medicine Clinic

From the 2019 HVPAA National Conference

Dr. Kristen Young (University of Arizona College of Medicine – Phoenix), Dr. Bryan Mahoney (University of Arizona College of Medicine – Phoenix), Dr. Jeremy Sherer (University of Arizona College of Medicine – Phoenix)

Background

Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone, which leads to skeletal fragility. Patients with osteoporosis are at risk for fractures, especially in the hip, spine, and wrist. The costs associated with treating osteoporotic fractures in the elderly were estimated in 2002, and were about $16 billion in the US (Blume, 2011). The financial burden of hip fractures alone exceeds $3 billion dollars (Weyler, 2007). Fractures can be prevented through screening, identification, and intervention through lifestyle and pharmacologic treatment. Screening for and treating osteoporosis is currently recommended by the United States Preventative Task Force (USPFTF) for women greater than 65 and women younger than 65 who are at significant risk using a clinical risk assessment tool, such as the FRAX tool.

Objective

To improve the quality of care we provide in an Academic Internal Medicine Clinic by increasing our osteoporosis screening rates and evaluate the value of screening for osteoporosis.

Methods

We will query our electronic medical record (EMR) to identify internal medicine clinic patients who are female, age 65 or older, who are due for osteoporosis screening. We will identify our baseline screening rates for osteoporosis using dual-energy x-ray absorptiometry (DEXA). For patients that are noted to be at risk for osteoporosis based on age and sex, we will send a letter to both patient and provider.  During this time period (April 2019-June 2019), we will also provide additional education on osteoporosis and screening to attending physician and resident physicians in the internal medicine clinic through lecture, pamphlet, and posted signage in the clinic.  In June 2019, we will re-query our EMR for patients due for osteoporosis screening to compare a pre-/post- rate. We will conduct a baseline, anonymous, survey of our internal medicine residents evaluating the knowledge, attitudes and perceptions of osteoporosis screening. We will repeat this survey in late June 2019 and compare pre-/post- intervention results.

Results

We identified 71 out of 162 patients in our initial review were up to date for osteoporosis screening, based on current guidelines, or a baseline rate of 44%.  Of the 91 patients due for osteoporosis screening, 35 were noted to have additional risk factors for secondary osteoporosis. Two patients who were due for osteoporosis screened were found to have pathological fractures prior to first osteoporosis screening.

There were 39 internal medicine respondents to the survey. All residents agreed osteoporosis in an important, 31% were unsure or did not know how to screen and treat osteoporosis. 57% reported that the routinely screen for osteoporosis in the outpatient clinic. 26% of residents correctly answered a knowledge based question for treating and follow up of osteopenia. 20% of residents could identify a factor that is associated with increased risk for osteoporosis.

Conclusions

We identified a low rate of osteoporosis screening in our outpatient academic internal medicine clinic. Physician uncertainty in guidelines and follow up are two of the main contributors to low screening rates. Through further interventions using education, direct patient education, and EMR health maintenance reminders, our goal is to increase our screening for osteoporosis by 10%.

Clinical Implications

Appropriate, guideline-based screening, for osteoporosis can prevent pathological fractures. improve quality of life and decreased costs of care for of our patients.

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