Bisphosphonate Mitigates Gap in Osteoporosis Detection, Management

Orysia Kozicky, MD

A new initiative increased early bisphosphonate initiation following fragility fractures to help mitigate the gap in osteoporosis detection and management, according to new findings.

The findings were presented as part of the 14th Annual North American Young Rheumatology Investigator Forum.

Although osteoporosis screening and treatment are typically advised, execution falls short. Only 20.5% of patients were treated for osteoporosis in 2011, which was a nearly 50% decrease from 2002. Orysia Kozicky, MD, and colleagues conducted a project to improve osteoporosis management within the inpatient setting by advocating for the initiation of bisphosphonates in patients admitted for fragility fractures.

The team reviewed 2015-2017 prescribing practices for patients admitted with fragility fractures. Orthopedic and medicine providers were educated about evidence-based practices and indications to treat osteoporosis following a fragility fracture. Daily fracture admissions were monitored with ICD 10 codes for vertebral, wrist, femoral, and ankle fractures.

Kozicky and the investigators reviewed charts to ensure fragility fractures criteria met and collected other variables including DEXA, prior bisphosphonate use, and renal function. They spoke with providers through an email fact sheet and a HIPAA-compliant messaging forum to initiate a bisphosphonate at the time of discharge.

Following a six-month intervention, there was an increase from 3% to 34.7% of total patients who were newly prescribed a bisphosphonate. A majority of the patients were admitted for hip fractures.

The investigators noted implementation barriers such as concern that early bisphosphonate use delayed post-operative bone healing, which was a concept dismissed by a 2015 meta-analysis. The barrier was significantly overcome due to continued reiteration of the treatment benefits and reinforcement through emails and the HIPAA-compliant messaging forum.

Limitations to the study included a heavy oversight by project coordinators given daily admission data review, emails, and forum messages. Surgeons also underutilized consults. None of the 8 renal insufficiency patients received consultation. To improve the initiative, it is necessary to assess outpatient osteoporosis therapy compliance following discharge and to integrate an osteoporosis treatment alert within the EHR.

“Inpatients providers are uniquely posed to initiate osteoporosis treatment following a fragility fracture given the opportunity for prompt intervention implementation. By illustrating the importance of osteoporosis therapy, this initiative increased early (bisphosphonate) initiation following fragility fractures to help mitigate the gap in osteoporosis detection and management within this institution,” the investigators wrote.

The study, “Bisphosphonate Initiation for Fragility Fractures: A Quality Improvement Initiative in Patients Admitted with Fragility Fractures,” was presented at the North American Young Rheumatology Investigator Forum.