(P44) Optimizing Osteoporosis Intervention After Fragility Fracture in Post-Acute Long-Term Care

Objective/Aim: To provide education to patients, family, and SAR providers, initiating interventions, and to assist with transition to community healthcare providers for further care. This is especially paramount given current aging population projections and the overall incidents of falls in the elderly.

Background: Fragility fractures, defined as skeletal fractures caused by low-impact injury (e.g. falls/trauma from standing height or less), are strongly associated with underlying osteoporosis. Unfortunately, osteoporosis is often underdiagnosed and left untreated in patients discharged from hospital after acute fracture. Post-acute long-term care (PALTC) facilities offer a unique setting to identify high risk patients and to initiate a path to secondary prevention for osteoporosis. The aim for this QI project was to increase identification and management of fragility fracture-related osteoporosis by PALTC providers utilizing staff education and the implementation of a standardized management protocol by November 2022.

Quality Improvement

Methods: We identified patients with primary diagnosis of fracture admitted to PALTC from 7/1/2022 – 11/4/2022. Fractures were characterized as fragility based on review of history and nature of injury that led to fracture. In-service education was provided to five PALTC providers (3 physicians, 2 advanced practice practitioners) to guide use of an admission protocol for evaluating secondary causes of osteoporosis, assessing baseline bone density via dual-energy X-ray absorptiometry (DXA), initiating treatment for bone health (vitamin supplementation, bisphosphonate therapy), and/or facilitating specialty endocrine referral. Effectiveness of intervention was determined by documentation of any intervention initiated by PALTC providers recorded in the electronic medical system.

Results:
The study included 92 patients identified with fragility fracture, age 68 –101 years (mean 85.6), admitted to PALTC from 7/1/2021 - 10/31/2021. Pre-intervention group consisted of 47 patients, of which 21 received any intervention (44.7%). Following provider education and implementation of the revised admission protocol, 43 of 44 post-intervention patients received one or more intervention (97.7%). This correlated with a 53% increase in action implemented by PALTC providers. Chi-square analysis was performed and showed increase in provider intervention between pre-and post-intervention patient groups was statistically significant (P < 0.0001). Most commonly encountered fractures were femur (45%), vertebral (23%), pubic rami (13%), humerus (11%), tibial (5%), and others (3%).

Conclusions:
This study highlights that with effective provider education and implementation of standardized management protocol, the identification and treatment of osteoporosis in fragility fracture patients can be successfully initiated in the PALTC setting. Next steps include analysis of long term outcomes for patients once transitioned to community providers, more specifically continuity of evaluation and management, specialty referral follow up, treatment adherence, and overall risk reduction of recurrent fracture.