Background/Purpose: Non-traumatic vertebral and hip fractures are detrimental complications of osteoporosis and those with a previous fracture have double the risk of subsequent fractures. The objective of this quality improvement (QI) project was to determine the baseline characteristics that may have contributed to the vertebral or hip fracture and determine if bone health was optimized subsequent to the fracture. Our institution determined the need for a pharmacist-driven clinic to assist patients with incidental vertebral and hip fractures receive appropriate follow-up care to prevent future fractures. This analysis completes the initial analysis that focused on patients who had an outpatient prednisone prescription prior to admission. 

Methods: Data was retrospectively collected from the electronic health record for patients aged 45 and older admitted to UF Health Jacksonville for an active vertebral or hip fracture diagnosis between January 1, 2017 and January 31, 2019. Traumatic injuries were excluded. Retrospective chart review could occur dating back to January 2014 for completeness.  Data on patient demographics, any medication that may affect bone health (e.g. steroids, calcium and vitamin D products, bisphosphonates, etc.), DXA scans, and pertinent labs were collected.

Results: A total of 287 patients were admitted 296 times between January 1, 2017 and January 31, 2019. Of these, 100 patients were screened and 33 patients were excluded. For the 67 hospitalized patients included in this analysis, 44 (65.7%) had a hip fracture and 23 (34.3%) had a vertebral fracture.  A majority, 62.7%, were female with a mean age of 67 years old (range 46-97 years old). A total of 4 patients (6%) had a DXA scan prior to admission and 7 patients (10%) had a DXA scan after admission.  No patient analyzed had chronic glucocorticoid dose ≥ 5 mg/day prednisone equivalent for greater than 3 months. A total of 17 patients had prednisone bursts with 23.5% of patients having cumulative burst doses between 10-100 mg, 52.9% patients between 101-500 mg, 5.9% patients between 501-1000 mg, and 17.7% patients > 1000 mg. Patients were also on other medications that may affect bone health with the highest rates of concomitant medication use being proton pump inhibitors 43.3%, antiepileptics 40.3%, serotonergic receptor inhibitors 31.3%, and levothyroxine 16.4%. Only 3% of patients were on a bisphosphonate prior to admission and 3% were newly started after admission. One patient was on denosumab prior to and after admission. Baseline vitamin D deficiency observed in 25.4% of patients.

Conclusion: In this convenience sample of patients with an active non-traumatic vertebral or hip fracture prior to admission, the rate of baseline DXA scan was low (6%) and after admission DXA (10%).  The rate of pharmacologic antiresorprtive therapy after admission was 7.5%.  The goal in development of this novel pharmacist – driven care pathway and clinic is to create a post-discharge process for patients admitted to the hospital for vertebral or hip fractures to optimize bone health by mitigating modifiable risk factors and increasing appropriate osteoporosis medication prescriptions to reduce the future risk of fractures. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pharmacist-driven-clinic-development-for-patients-with-incidental-vertebral-or-hip-fractures/