Background/Purpose:  Despite the availability of effective therapies for fracture prevention, osteoporosis screening and treatment rates in practice are low.   Fracture liaison services are effective at reducing secondary fractures, but primary prevention models are limited.  The Salt Lake City VA Health Care System (SLCVAHCS) partnered with primary care providers (PCPs) to develop a bone health team (BHT) to improve the management of patients at risk for osteoporosis.  This analysis compared patients enrolled in the BHT to similar patients with standard management.

Methods: Patients enrolled in the community-based outpatient clinics (CBOCs) of the SLCVAHCS from Feb 1, 2012 – Feb 1, 2015 were included if 1) the patient was enrolled in a CBOC PCP panel for 1 year prior to the date of implementation of the BHT, 2) had one PCP visit during this interval and 3) men age ≥70 and women age ≥65.  Exclusion criteria were 1) no PCP assignment; or, 2) death in the pre-index period. The primary intervention was placement of a BHT e-consult.  Primary outcomes were: completion of dual energy x-ray absorptiometry (DXA) scan; 25(OH) D measurement; diagnosis of osteopenia or osteoporosis; and initiation of osteoporosis medication.  All patients started out as unexposed, but some went on to receive the primary intervention; patients were followed until the earliest of: occurrence of a primary outcome; or, the end of the observation period.  Between group differences were analyzed using a Cox proportional hazards model with enrollment in BHT as a time-dependent exposure.  Multivariable regression models adjusted for age, sex, multiple co-morbidities, baseline pharmacologic agents, site of CBOC, and PCP discipline.

Results: Of the 7,644 patients evaluated, 975 were enrolled in the BHT.  This cohort was predominantly male (97.8%) with an average age of 79.8 years.  Patients enrolled in BHT were significantly younger, more likely to live in rural areas, and more likely to have a physician as a PCP versus those not enrolled in BHT. More patients in BHT had diabetes, a prior diagnosis of osteoporosis and osteopenia, prior treatment with osteoporosis medications, and a greater likelihood of having been seen by a nurse practitioner.  Fewer patients in the BHT had been seen by a physician’s assistant, had vitamin D deficiency, or had prior vitamin D testing.  In both univariate and multivariable regression analyses, patients in BHT were significantly more likely to undergo DXA, 25(OH) D testing, be diagnosed with osteopenia or osteoporosis, and be treated with osteoporosis therapy (Table). 

Conclusion: BHT implementation significantly increases the rate of screening, diagnosis, and treatment of osteoporosis in CBOCs of the SLCVAHCS.  The impact on fragility fractures will require longer follow-up.  Similar programs could be considered to improve the primary prevention of osteoporosis in other primary care settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/implementation-of-a-bone-health-team-markedly-improves-osteoporosis-screening-diagnosis-and-treatment-initiation-rates-compared-to-standard-primary-care-practice/