Evaluating the Utility of Osteoporosis Screening Tools (Ost, Frax) and Video Education in Hospitalized Patients

Background:

            Eight million women and two million men in the US suffer from osteoporosis, with the cost of fragility fractures an estimated $10-15 billion annually.

Methods:

Two osteoporosis fracture risk assessment tools were used. The FRAX (Fracture Risk Assessment Tool), and a simpler tool, the OST (Osteoporosis Self-Assessment Tool), a calculation using only age and weight.

An OST was calculated on internal medicine inpatients >60 years old.  112 patients with an OST > 2, deemed not at risk for osteoporotic fracture then had a FRAX calculated by chart review.  The 72 patients with an OST < 2, deemed at risk for osteoporotic fracture, were consented for further study.  Patients were excluded if they were not interested in participating, had altered mental status or were too sick to participate.

Patients answered the FRAX questionnaire. They then performed 3 steps: 1) a 7-question osteoporosis pre-test, 2) an NIH-sponsored educational osteoporosis video, and 3) a repeat of the 7-question osteoporosis test. Afterwards, patients were asked their opinion of the video education, and if they would take any new measures after hospital discharge to help improve bone strength and prevent osteoporosis.

Results:

184 patients were evaluated, mean age 73 years old, and mean weight 91 kg. Causes for admission were primarily cardiovascular, pulmonary, and renal disease with only two patients admitted with bone fractures.  40% (n=72) of patients were found to be at risk for osteoporotic fracture by the OST calculation. There was a 94% (p=0.001) positive correlation for both major fracture and hip fracture risk by FRAX calculation.

Of the 112 patients not found to be at risk by OST, 92 (84%, p=0.01) correlated with low FRAX risk. Of the 20 patients where the FRAX found risk and the OST did not, 10 (50%) had an obvious secondary cause for osteoporosis such as a history of chronic renal failure or prednisone use.  Of the other 10 patients who did not have a secondary cause for osteoporosis, 8 of them were women over the age of 68, median age 74 years old.

30% (22) of the at risk patients had been previously counseled by their physician for osteoporosis, and 40% (29) were taking calcium supplements, vitamin D,12% (9) were taking bisphosphonates, and 36% (26) patients had a DEXA screen before hospital admission. 

With regard to patient education, we found an improvement of 20.6% when comparing quiz scores conducted before and after exposure to the NIH-sponsored educational video p=0.001.  Patients found this video very helpful in learning more about osteoporosis and preferred it to written material. After being informed of their risk, and after watching the video, 28% (20) patients said that they would address osteoporosis: 16 would make mild lifestyle changes and only 4 planned to speak with their doctor and pursue treatment. Patients who opted to not alter lifestyle or seek further medical advice regarding osteoporosis noted that they were too sick or too old.

Conclusions:

            The OST is an effective risk assessment tool for osteoporosis. OST does not capture those patients with obvious secondary causes for osteoporosis. Of those patients at risk, 60% had not had osteoporosis addressed by their primary care physician. Video education was well received in the hospital and revealed a significant improvement in knowledge about osteoporosis.  However, after being informed of their fracture risk and receiving education, only 28% of patients would pursue treatment.