Follow-up Key to Fighting Osteoporosis

Cecily O’Connor
RedwoodAge.com

Improved follow-up by orthopedists with their osteoporosis patients is standing out as a way to prevent more fractures. 

Electronic medical records are helping clear up a "disconnect" that generally occurs between a patient’s treating orthopedist and their primary care physician, said Dr. Adrianne Feldstein, an investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. 

Kaiser relies on a computerized database to monitor and follow patients with fractures, which has helped increase physician communication, as well as the monitoring of individuals susceptible to bone fractures, according to results of a new Kaiser study that was funded in part by Merck & Co., which makes the osteoporosis treatment Fosamax. Outreach through e-mail, letters and phones calls to patients and their primary care doctor, also has made a difference. 

"This (electronic medical record) intervention has broad applicability to a large group of health care providers, from local health departments to HMOs and PPOs, with access to electronic billing or clinical data," she said. "…These health organizations can make sure their patients with fractures get appropriate bone density screening follow up."

Kaiser’s study of 3,588 women found that an outreach program targeted to patients with a previous fracture resulted in an improvement from 13.4 percent to 44 percent of patients being evaluated or treated for osteoporosis. Osteoporosis management involves the receipt of a bone mineral density measurement (BMD) or osteoporosis medicated during the six months after a fracture. 

"If widely implemented, this approach could substantially improve the secondary prevention of osteoporosis," according to the study. 

Osteoporosis is a common condition in older adults. Half the women over age 50 will have an osteoporosis related fracture before they die, with broken bones generally occurring in the hip, spine and wrist, according to the National Osteoporosis Foundation. One in four men over 50 will e affected by the brittle bone disease, too. 

While osteoporosis is preventable, even reversible when detected early, many patients do not receive the necessary BMD screening and subsequent treatment. It’s estimated that in 2005, there were 2 million fractures at a cost of $17 billion in the US, according to Kaiser. By 2025, the number is expected to increase by 50 percent as the baby boomer generation ages. 

"Osteoporosis now causes  more deaths annually than breast cancer and ovarian cancer combined," Dr. Feldstein said. "This study shows that we can cost-effectively improvement management with interventions as simple as e-mails, letters and phone calls."

Kaiser researchers analyzed the medical records of 3,588 woman over 67 who sustained clinical fractures. These women had not received a BMD measurement or osteoporosis treatment in the 12 months before the fracture. 

In Phase 1 of the study, primary care physicians with eligible patients were sent an electronic medical record message that contained patient-specific advice consistent with national guidelines, as well as offered outreach to the patient. If the physician chose, patients were contacted via an introductory letter and phone call by outreach staff, who completed a patient record review, counseled the patients regarding risk of osteoporosis and future fractures, and ordered laboratory testing, medication, or a BMD measurement. During Phase 2 clinicians and staff were eligible for a financial incentive for quality improvement based on the osteoporosis HEDIS measure.

"Although the financial incentive helped staff define what the organizational priority was, being a team player is what drove behavior," said Dr. Feldstein. "The increase in performance resulted from re-engineering the patient’s care and ensuring continuity of care from orthopedist and primary care physician."