Background: Fracture Liaison Services (FLS) are traditionally outpatient-based and led by orthopedists or endocrinologists. In the United States, over 1 million patients are hospitalized yearly with osteoporotic fractures and internal medicine hospitalists are frequently involved in their co-management.
Purpose: Internal medicine hospitalists have an integral role in the prompt recognition and early treatment of patients hospitalized with acute osteoporotic fractures, which improves ongoing outpatient management.
Description: Methods: In August 2019, an internal medicine hospitalist physician and nine advanced practice providers formed a novel hospital medicine based FLS team to treat inpatients on the general medicine, neurosurgical, orthopedic and surgical teams who fulfilled criteria for a low impact fracture. Patients were evaluated for secondary causes of osteoporosis, vitamin D insufficiency, eligibility for starting oral anti-osteoporosis therapy and referred for bone density scanning and ongoing outpatient management.Results: Within the first 3 months of service launch, 103 inpatients were identified as having a probable acute osteoporotic fracture. Hip and vertebral fractures were most commonly seen and accounted for 38% and 19%, respectively. The capture rate of hip fractures was 84.6% and estimated capture rate of vertebral fractures was 42.2%. 49% were identified as having vitamin D deficiency. Of eligible patients (no medical contraindications) 73% were started on anti-osteoporosis medication, 84.4% of patients were started on vitamin D/calcium supplements and 40.3% were referred to bone density imaging at the time of discharge. Clinical documentation and coding of hip fractures improved from 33% to 95% and consult notes averaged 3.1 Relative Value Units (RVUs) per note.
Conclusions: Conclusion: A hospitalist-led FLS is a unique and sustainable approach to osteoporosis care that significantly improved the diagnosis and initial management of hospitalized patients with acute osteoporotic fractures. Outpatient follow-up data are needed to evaluate adherence to this initial management over time.