Implementing a Fracture Liaison Service in an Orthopaedic Practice: Improving the Rate of Osteoporosis Diagnosis and Treatment in Patients with a Recent Fracture

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Osteoporosis is a silent disease that entails progressive loss of bone mass and weakened bone architecture, placing patients at risk for osteoporotic fragility fractures. Approximately 2.3 million fragility fractures occur annually, with an estimated cost of $19 billion. Over 40% of these patients require hospitalization, and the 12 month mortality rate after fracture is 20%. The occurrence of a fragility fracture is a significant risk factor for sustaining additional fractures. The United States healthcare system is failing to appropriately identify and treat patients with osteoporosis-related fragility fractures. According to The Health Employer Data Information Set, only 22% of fragility fracture patients underwent appropriate diagnostic workup or began treatment within the six month period following their fracture. The purpose of this project was to implement a Fracture Liaison Service (FLS) in an orthopaedic practice to improve the rate of diagnosis and treatment of osteoporosis in patients with a recent fracture. Standard workflows were created to identify fragility fracture patients and refer them to the FLS, which was staffed by an orthopaedic physician assistant and a registered nurse. Oversight was provided by the Executive Medical Director of Musculoskeletal Services. Results were reported in four domains: (1) referral to the FLS: pre-intervention 0%, post-intervention 38%; (2) letters sent to the patients’ primary care providers indicating that their patient has sustained a fragility fracture: pre-intervention 0%, post-intervention 42%; (3) DEXA scan completed within six months of fracture: pre-intervention 29%, post-intervention 57%; and (4) prescription osteoporosis medications prescribed within six months of fracture: post-intervention 15% (pre-intervention data not available). Patient education via referral to the FLS, communication with primary care providers, and the rate of obtaining DEXA scans were improved by the FLS, but the rate of post-fracture pharmacologic treatment did not meet expectations.



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