Background/Purpose: It has been estimated that 12 million Americans over the age of 50 have osteoporosis. Of those, only 30% of eligible women age 65 and older have had a bone density test. Previous studies of academic hospitals with resident outpatient primary care providers have concluded that residents are following the current guidelines for screening for osteoporosis with DEXA scans. However, the use of The Fracture Risk Assessment Tool (FRAX) score for the identification of patients at high-risk for fracture is highly underutilized. Further education of residents in the form of a didactic lecture may improve the osteoporosis screening practices among house staff.  

Methods: Resident outpatient primary care providers in the Internal Medicine Department at one academic medical center were given a didactic lecture on the principles of osteoporosis screening, including current guidelines and utilization of the FRAX score. The electronic medical record system at two outpatient care centers was reviewed for one week prior to and one week after the didactic lecture. Patients with the following screening criteria were identified: women over age 65 or men over age 70, and postmenopausal women with at least one documented risk factor, including previous fracture, parent with a fractured hip, current smoking, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, and alcohol use (three or more drinks/day). Each chart was evaluated for osteoporosis risk assessment by house staff.

Results: Eleven Internal Medicine residents were present for the didactic lecture. Five residents were PGY1 level, three residents were PGY2 level, and three residents were PGY3 level. 73% were male and 27% were female. A total of 59 patients met the criteria for chart review during the one week prior to the didactic lecture. Of those 59 patients, 13 (22.0%) had osteoporosis risk addressed during that visit. A total of 79 patients met the criteria for chart review during the one week after the didactic lecture. Of those 79 patients, 32 (40.5%) had osteoporosis risk addressed during that visit.

Conclusion: A didactic lecture improved osteoporosis screening from 22.0% to 40.5%. This results in a relative increase in screening by 54.3%. After the lecture, residents achieved a higher screening rate than is nationally achieved at this time1. It is imperative that house staff be further educated on current osteoporosis screening tools, such as the FRAX score, to better prevent future fracture among those at risk. An expanded study should include a longer time period of chart review, in order to further evaluate the impact of didactic lecture on current practices in the resident-led outpatient setting.

References:

1. U.S Preventive Services Task Force. Screening for Osteoporosis: U.S Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 1 March 2011. Vol 154, no 5.

2. J. Brodsky, M.D.; M. Greenfield, M.D., E. Patton, M.D. Osteoporosis Screening and Fracture Risk Assessment Tool Usage Among House Staff. Poster presentation: Interdisciplinary Osteoporosis Symposium 2013, Chicago, IL.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-didactic-lecture-on-osteoporosis-screening-and-fracture-risk-assessment-among-house-staff/