Implementing a Clinical Risk Assessment Tool to Improve Bone Health in Postmenopausal Women

To improve staff knowledge of osteoporosis and increase the identification of fracture risk in postmenopausal women by implementing use of the Fracture Risk Assessment Tool (FRAX) in an outpatient setting.

Quality improvement project guided using the Plan-Do-Study-Act cycle.

In a low-income primary care clinic, no standardized fracture risk assessment tool was being used, leading to inconsistency in referrals for dual-energy X-ray absorptiometry (DXA).

Office staff and postmenopausal women ages 50 to 64 years.

A standardized process was designed to promote appropriate osteoporosis management to improve the assessment, diagnosis, and treatment of osteoporosis in postmenopausal women. Staff training was provided before project implementation. Outcome measures included pre-post Revised Osteoporosis Knowledge Test, FRAX adherence, and DXA referrals.

Staff knowledge improved by 25.8% after completion of staff training. During the 2-month implementation period, FRAX adherence was 96.3% (n = 156) among the 162 eligible women, and 98.6% of DXA referrals (n = 70) were completed for the 71 women identified with a major osteoporotic fracture risk greater than 8.4%.

With this quality improvement project, we successfully implemented the FRAX tool in the outpatient setting. Initial high adherence rates for FRAX screenings and DXA referrals demonstrated advancements made in clinical practice to provide evidence-based care to postmenopausal women at the greatest risk for an osteoporotic fracture.