An Osteoporosis Screening And Treatment Bundle To Reduce Care Gaps After Fragility Fracture

Background: Osteoporosis is characterized by decreased bone density and leads to fragilityfractures if left untreated. Over twelve million adults over the age of fifty are at risk for thecondition. The fracture risk assessment tool (FRAX) is a validated screening measure thatascertains a 10-year fracture risk. Currently, advanced practice providers (APPs) do not use ascreening tool to address future fracture risk and lack a process to refer patients to a fractureliaison service (FLS).Objective: The objective of this quality improvement (QI) project was to encourage a practicechange among APPs to use a FRAX screening tool to address fracture risk and develop a referralorder to a FLS.Methods: A 6-week PDSA model was used to implement the interventions. Seven orthopedicAPPs participated in an expert-led session on osteoporosis screening and management. Pre- andpost-surveys evaluated their awareness. Compliance was measured by reviewing charts over 6weeks to evaluate the percentage of patients screened. A secondary aim was to develop anambulatory referral order to support referring patients with a fragility fracture for osteoporosisevaluation by an APP-led FLS.Results: Analysis of APP familiarity with the FRAX screening observed an increase infamiliarity from 17% in the pre-survey group to 60% in the post-survey group. After thecompletion of the educational session, out of forty-four charts reviewed 88% (39/44) had adocumented FRAX score, well above the 50% expected goal. Importantly, among screenedpatients 64% (25/39) were started on osteoporosis treatment: 67% (23/34) of females and 40%(4/10) of males. Finally, an ambulatory electronic referral order to the FLS was successfullydeveloped.Conclusions: The QI project’s primary aim to promote a practice change among APPs noted agreater than 88% compliance rate for FRAX score documentation. Furthermore, 64% of patientswith a high FRAX score were started on AOM treatments by an APP-led FLS, a key driver inreducing the osteoporosis treatment gap. Moreover, the development of an FLS referral ordercreated a sustainable process that reduces current treatment gaps after a fragility fracture.