Clinical efficacy of a fragility care program in distal radius fracture patients

Abstract

Purpose: To assess the quality of an initiative to improve the diagnosis and management of osteoporosis in patients over 50 years of age with distal radius fractures (DRF).

Methods: A retrospective review was conducted to determine the baseline percentage of individuals undergoing osteoporosis screening after DRF. Thereafter, a study was implemented in which DRF patients who were not being treated for osteoporosis or had not recently undergone screening were offered a dual-energy x-ray absorptiometry scan and referral to endocrinology at the initial hand surgery clinic visit. Patients who declined participation were contacted by a patient educator to discuss the benefits of screening and address their concerns. Those who then wanted to receive an osteoporosis evaluation were scheduled for bone scanning and endocrinology consultation.

Results: During the baseline period, 7 patients (15%) were screened, and 41 (85%) were not screened. During the active phase of the initiative, 82 patients over 50 years of age were treated for a DRF at our institution. A total of 44 patients were identified for potential osteoporosis screening, and 35 patients met inclusion criteria. Of these, 19 (54%) agreed to screening after the initial orthopedic evaluation, and 16 declined. After speaking to a patient educator, 9 of these 16 patients agreed to screening. Of the remaining 7 patients, 4 again declined screening and 3 were unavailable by telephone. Overall, 80% of patients who were identified in the initiative agreed to osteoporosis screening after the combination of recommendation during hand surgery clinic visit and patient education by telephone, and 64% were diagnosed with osteoporosis/osteopenia as a result of completing screening.

Conclusions: An integrated model of care among orthopedic surgeons, patient educators, and endocrinologists substantially increased screening for osteoporosis after DRF.

Type of study/level of evidence: Prognostic II.

Keywords: Distal radius fracture; osteoporosis fragility.