Osteoporosis awareness protocol for patients with fragility fractures.

OBJECTIVE: To develop and implement a protocol that improves recognition of osteoporosis in patients with fragility fractures. METHODS: The awareness protocol included 6 meetings with the clinical staff of the emergency department (ED) and the orthopedic department to discuss osteoporosis awareness, a poster placed in the ED triage and orthopedic residents' rooms, monthly verbal awareness reminders, and distribution of pocket-sized poster copies to the residents. RESULTS: Two hundred ninety-one patients with fractures were admitted to Howard University Hospital from June 2005 - December 2005. Fractures were evident in 11% (n = 32). All were admitted from the ED. Of the patients with fractures, 81% were African American--62.5% were women with a mean age of 73.3 +/- 15.8 years; the mean age of the men, 59.3 +/- 14.9 years. The orthopedists requested an endocrine consult for 8 patients. Osteoporosis was evident in 25% of the fracture patients (n = 8). One of these patients was diagnosed on the basis of risk factors, thus 22% were diagnosed on the basis of dual-energy x-ray absorptiometry and pathological findings. As compared with a prior study, this is a significant increase (13%, p = .02) in the diagnostic rate at this institution. Bisphosphonates were prescribed for 3 of the 32 patients (9%) prior to discharge. CONCLUSION: This pilot study presents an easy-to-execute awareness protocol that significantly improved the diagnosis of osteoporosis in a predominantly African American population with fractures. The diagnosis of osteoporosis may be enhanced by cooperative efforts among ED, orthopedics, endocrinology, and other disciplines.

Low bone mass and fractures on foot radiographs: missed opportunities to evaluate for osteoporosis: a pilot study.

BACKGROUND: Osteoporosis is often unrecognized, even in the presence of radiologic evidence of vertebral or nonvertebral fragility fractures. METHODS: Ninety patients aged 50 years and older with radiographs of the foot taken at Howard University Hospital between 2003 and 2005 were randomly selected. In phase 1, standard radiograph reports were reviewed for evidence of osteopenia, fractures, or both. In phase 2, risk factors for osteoporosis and dual energy x-ray absorptiometry scans were obtained. RESULTS: In phase 1, radiologists reported all of the fractures for all 90 participants; however, osteopenia was reported in only 54.7% of these. In phase 2, for 50% of the participants with radiographic evidence of osteopenia, fractures, or both, there was no evidence that the clinicians evaluated risk factors for low bone mass or requested a dual energy x-ray absorptiometry scan. Of participants who had radiographic evidence of osteopenia, osteoporosis, or both, 83.3% met the criteria for dual energy x-ray absorptiometry scans. CONCLUSIONS: Osteopenia or fracture observed on radiographs of the foot are predictive of low bone mass but are often not evaluated.