Background Osteoporosis is a common disorder and an important cause of morbidity and mortality in the United States. Although there are effective treatments for the treatment of osteoporosis (such as bisphosphonates), studies have shown that even in patients with osteoporotic fractures, providers do a poor job of diagnosing and treating osteoporosis.
Purpose of Study To determine what percentage of patients in a large Veterans Affairs (VA) hospital who had sustained an osteoporotic fracture received postfracture evaluation and evidence-based treatment for osteoporosis. We hypothesized that less than 50% of these patients receive evidence-based postfracture evaluation and treatment.
Methods Used Retrospective analysis of hip fracture data using a centralized VA database (CHIPS). Fracture cases (men and women) were identified in the years 1996-2005 using appropriate ICD-9 codes for hip fracture that were associated with radiology examinations within 30 days of the ICD-9 code. Identifying the index date of fracture as the date of the radiology examination, we determined whether DEXA scans were performed in a 6-month period following the fracture date and whether FDA-approved osteoporosis drug therapy was initiated in the same 6-month period.
Summary of Results There were 438 men and 29 women with hip fractures from 1996 to 2005. Of the 467 patients with osteoporotic hip fractures, only 21 (4.5%) had A DEXA scan within 6 months of their fracture and only 5% of the patients were started on treatment for osteoporosis with either a bisphosphonate, calcitonin, or hormone replacement therapy within this time period.
Conclusions The Portland VA Medical Center experience resembles published reports of osteoporosis management in the community, indicating very low rates of diagnostic and therapeutic steps taken to address a treatable condition, osteoporosis. Future efforts should be directed at determining the variables responsible for substandard provider management of these high-risk patients.
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