More that 1.5 million fractures result from osteoporosis annually in the United States at a cost of fifteen billion dollars. Less than 25% of patients who sustain a fragility fracture receive treatment for osteoporosis. We hypothesize that many hospitalized patients with osteoporosis go undiagnosed.
From 2007 2010, 790 patients, >age 50, were identified by ICD9 diagnoses for fragility fractures in our Emergency Department. Patients were excluded if chart review revealed: a fracture not consistent with a fragility fracture, or pre and postfracture care at another facility. Patients were also excluded if they could not be contacted, were demented, or deceased. 320 patients with insufficiency fractures remained in the study and responded to a phone survey. They were asked about a prior diagnosis of osteoporosis and the administration of a Dexa scan, Calcium and Vitamin D. The medical records were reviewed for all hospitalizations 5 years prior to the patient’s fracture. Data collected included the principle diagnosis, age, weight, 25OHVit D level, Dexa scan results, and osteoporosis medications. The Osteoporosis SelfAssessment Test (OST) was utilized to calculate a fracture risk assessment score based on weight and age. Using the Spearman test, we assessed the correlation between the OST score and the lumbar and hip DEXA scores.
127 of the 320 patients (40%) were hospitalized within the past 5 years. These 127 patients were admitted 312 times with a mean of 2.5 hospitalizations per person. The top 5 reasons for hospitalization included: Cardiac 69/312 (22%), Infectious 60/312 (19%), Musculoskeletal 55/312 (18%), Gastrointestinal 38/312 (12%) and Neurologic/Psychiatric 33/312 (11%). 78% of patients were female, 22% male and the mean age was 74 years old. 45% had a prior diagnosis of osteoporosis. 63% took calcium and vitamin D prior to their fracture and 19% took other osteoporosis medication. 11% had a 25OHVit D level mean level of 26ng/ml. 39% had a Dexa scan prior to the fracture and an additional 15% had Dexa scan within 3 months after the fracture. The mean lumbar Tscore was 1.71 and the mean hip Tscore was 2.17. The mean OST score was 1.47 (an OST value < 2.0 indicates osteoporosis risk). The OST score did not correlate with the lumbar Tscore, but it did correlate moderately with the hip Tscore.
Forty percent of patients >50 years old who sustained an osteoporotic fracture had been hospitalized during the previous 5 years. Of those patients, the majority had not received osteoporosis screening or treatment. The OST scores correlated moderately with the hip Tscore value. An OST value of <2 correlated with fracture. Osteoporosis screening and treatment should routinely be evaluated in the hospital. Perhaps the simple OST score can function as the initial hospital screening tool.
To cite this abstract:Weber C, Hennrikus E, Rizvi N. Hospitalization: A Missed Opportunity to Assess for Osteoporosis. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97625. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/hospitalization-a-missed-opportunity-to-assess-for-osteoporosis/. Accessed January 19, 2020.