Background/Purpose:

Osteoporosis is a common bone disorder that places patients at risk of pathologic fractures. Osteoporotic fractures can be devastating and associated with significant morbidity, mortality and economic burden. Rheumatologic patients especially those with rheumatoid arthritis (RA) are known to have higher risk of low bone mineral density and osteoporosis. This is more pronounced in patients with active/severe disease and those taking glucocorticoids. Early diagnosis and treatment of osteoporosis can prevent fractures and their grave sequelae. In this study we aim to evaluate the rate of osteoporosis screening using the standard Dual-Energy X-ray Absoptiometry (DEXA) scans in our rheumatology clinic before and after introducing a simple and cost-effective intervention to improve this rate. Our target for screening is women at age of 65 or older, rheumatoid arthritis patients, and/or patients taking prednisone =/>7.5 mg daily for more than 3 months.

Methods:

Patients seen in our rheumatology clinic during September-November 2016 were identified as baseline pre-intervention group. Intervention period was between January-March 2018. During this period, bright orange cards highlighting the indications for osteoporosis screening were added by clinic staff to every patient’s chart at time of check-in. At the end of the intervention period, the data was collected by sorting patient’s medical record numbers in descending numerical order and the top 100 patients in each group were analyzed. The following data was collected: age, gender, rheumatologic diagnosis, chronic moderate to high dose steroid use (defined as systemic steroid dose equivalent to prednisone =/>7.5 mg daily for more than 3 months), and DEXA scan orders. In each group, the total number of patients who had an indication for osteoporosis screening as defined in our study was determined as well as the total number of DEXA scan ordered for such indications.

Results:

Combined analysis of both groups revealed that 84% (169/200) of total patients were women of all ages, 14% (28/200) were women age 65 or older, RA patients were 53% (107/200), and patients on moderate to high dose steroids were 37% (74/200). Separate analysis of each group revealed that 71 out of 100 patients in the pre-intervention group had an indication for osteoporosis screening as defined in our study, of those only 11 patients had a DEXA scan ordered (15%). In the intervention group, 75 out of 100 patients had an indication for screening and out of those 30 DEXA scans were ordered as indicated (40%).

Conclusion:

Majority of rheumatologic patients are at high risk for osteoporosis. Analyzing the data from our rheumatology clinic has shown that the rate of osteoporosis screening based on indications mentioned above were low. However, simple cost-effective reminders in the form of cards has more than doubled the rate of screening. Considerable improvement seen with this simple intervention and further improvement can possibly be achieved by incorporating reminders in the electronic medical records. Rheumatologists and primary care physicians are encouraged to closely evaluate rheumatologic patients for osteoporosis screening, prevention and treatment when indicated.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/simple-and-cost-effective-intervention-doubled-the-rate-of-osteoporosis-screening-in-high-risk-rheumatology-patients/