Hospitalist Orthopedics Team Approach to Improving Care of Osteoporosis for Fragility Hip Fracture Patients

Background:

Osteoporosis, the underlying cause of most hip fractures, is underdiagnosed and underrated. The Joint Commission's recent report on osteoporosis diagnosis and management showed that only 20% of patients with fragility or low‐impact fractures are ever tested or treated for osteoporosis. Bisphasphonates are highly effective in the treatment of osteoporosis. Optimal use of bisphosphonates requires adequate calcium and vitamin D intake before and dunng therapy. Adverse effects are rare but serious.

Methods:

We developed a process to improve osteoporosis care for patients with fragility hip facture. In this pilot project orthopedic surgeons consulted the hospitalist for osteoporosis management during hospitalization. The hospitalist evaluated patients for primary and secondary causes of osteoporosis, performed a diagnostic workup for secondary causes, and determined appropriateness of bisphosphonale therapy, Patients who had calcium and vitamin D deficiency were treated to normalize their levels. Patients received education on nutrition, exercise and bisphosphonate therapy for prevention of recurrence of fracture. For patients who required intravenous bisphosphonate therapy, arrangements were made with patients' primary care provider (PCP) or endocrinologisl for outpatient treatment. Results of evaluations and diagnostic workup were communicated with patients' PCPs to ensure appropnate follow‐up on discharge. A total of 50 patients participated in this pilot project

Results:

With use of this model, the Joint Commission's performance measures of osteoporosis management in acute care settings were met for all 50 patients (screening for osteoporosis, diagnostic workup for secondary cause, and bisphosphonate therapy on discharge). Workup for secondary causes revealed vitamin D deficiency in 23 of 37 (62%) and suboptimal calcium level in 26 of 41 (63%). Only 13 patients who were on bisphosphonate on admission were tested for hyperparathyroidism. Eight of 13 patients (61%) had suboptimal calcium and 25 (OH) vitamin D level and high PTH

Conclusions:

Early intervention for diagnostic workup of secondary causes and treatment of osteoporosis is important for prevention of recurrence of fracture in patients with hip fracture. This may best be accomplished by involvement of hospitalist in an acute care setting who can evaluate, provide a diagnostic workup and treatment of osteoporosis, and communicate with the PCP for follow‐up.

Author Disclosure:

A. Roy, none.