Osteoporosis awareness protocol for patients with fragility fractures

To develop and implement a protocol that improves recognition of osteoporosis in patients with fragility fractures.

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.

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.

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.