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Osteoporosis Screening and Treatment Among Veterans with Recent Fracture After Implementation of an Electronic Consult Service

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Abstract

Fewer than 24 % of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identification of and recommend management for patients with recent fracture. The E-consult service used clinical encounter data based on ICD9 diagnosis codes to prospectively identify patients with potential osteoporotic fractures. Eligible patients’ medical records were reviewed by a metabolic bone specialist, and an E-consult note was sent to the patient’s primary provider with specific recommendations for further management. Recommendations were initiated at the provider’s discretion. Between 2011 and 2013, the E-consult service identified 444 eligible patients with a low-trauma fracture who were not already on treatment. One hundred twenty-nine (29.1 %) consults recommended immediate bisphosphonate treatment, and 258 (58.1 %) recommended bone density assessments. Primary providers responded by prescribing bisphosphonates in 74 patients (57.4 %) and by ordering bone density testing in 183 (70.9 %) patients. At the facility level, prior to implementation of the E-consult service, the rate of osteoporosis treatment following a fracture was 4.8 % for bisphosphonates and 21.3 % for calcium/vitamin D. After implementation, the treatment rate increased to 7.3 % for bisphosphonates (p = 0.02) and 35.2 % for calcium/vitamin D (p < 0.01). While feasible and relatively low-cost, an E-consult service modestly improved the rate of osteoporosis treatment among patients with a recent fracture. These results suggest that a program with direct patient interaction is probably required to substantially improve treatment rates.

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Acknowledgments

This project was Funded by the VISN 6 Specialty Care Office. We are grateful for the assistance of Dr. Kim Voss, Dr. Parag Dalsania, Dr. Peter Chung, and Ms. Katherine McMullin. R. H. Lee, K. W. Lyles, and C. Colón-Emeric acknowledge support from the Duke Claude A. Pepper Center (NIA 2P30AG028716-08). Some results from this study were presented at the American Society of Bone and Mineral Research 2013 annual meeting in Baltimore, MD.

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Authors and Affiliations

  1. Durham VA Geriatric Research Education and Clinical Center, Durham, NC, USA

    Richard H. Lee, Kenneth W. Lyles, Megan Pearson & Cathleen Colón-Emeric

  2. Duke University Medical Center, DUMC Box 3470, Durham, NC, 27710, USA

    Richard H. Lee, Karen Barnard & Cathleen Colón-Emeric

  3. The Carolinas Center for Medical Excellence, Cary, NC, USA

    Kenneth W. Lyles

  4. University of Stellenbosch, Tygerberg, South Africa

    Karen Barnard

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  1. Richard H. Lee
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  2. Kenneth W. Lyles
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  3. Megan Pearson
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  4. Karen Barnard
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  5. Cathleen Colón-Emeric
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Correspondence to Richard H. Lee.

Additional information

K. W. Lyles has received research support from Novartis, Amgen, and Kirin Pharmaceuticals; has acted as a consultant for Novartis, Amgen, and UCB; is cofounder and equity owner of BisCardia and Faculty Connection; is the inventor of US Patent application “Medication Kits and Formulations for Preventing, Treating or Reducing Secondary Fractures after Previous Fracture” (12532285); is coinventor of US Patent Applications “Methods for Preventing or Reducing Secondary Fractures after Hip Fracture” (20050272707), “Bisphosphonate Compositions and Methods for Treating Heart Failure” (20104717), and “Bisphosphonate Compositions and Methods for Treating and/or Reducing Cardiac Dysfunction” (61/560,328). C. Colón-Emeric has acted as a consultant to Novartis and Amgen, is equity owner of Biscardia, and is the inventor of two use patents related to bisphosphonates and cardiovascular disease. The other authors report no conflict of interest.

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Lee, R.H., Lyles, K.W., Pearson, M. et al. Osteoporosis Screening and Treatment Among Veterans with Recent Fracture After Implementation of an Electronic Consult Service. Calcif Tissue Int 94, 659–664 (2014). https://doi.org/10.1007/s00223-014-9849-4

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  • DOI: https://doi.org/10.1007/s00223-014-9849-4

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