Diagnosing Osteoporosis at an Acute Rehabilitation Hospital-A Quality Improvement Project

As endorsed by leading endocrine societies, a fragility fracture of the hip or spine warrants a diagnosis of osteoporosis, irrespective of bone mineral density. A fragility fracture occurs from a force equal to or less than a fall from standing height, an event unlikely to cause a fracture in healthy bone. Physiatrists often manage patients with such fractures, including fractures stabilized by surgery. However, many patients are not diagnosed with osteoporosis during their acute hospitalization or rehabilitation admission, leading to suboptimal care and an increased risk of repeat fractures. This project involves a 6-mo retrospective review of 77 patients with fragility fractures at an acute inpatient rehabilitation facility, which found that none of the 77 patients were diagnosed with osteoporosis either at the time of admission or during their stay. To address this, the authors developed an educational flowchart for admitting providers and a "smart-phrase" shortcut within the electronic health record that automatically entered a diagnosis of osteoporosis into the patient's record. After intervention, 93% of patients (56/60) admitted with fragility fractures over 6 mos had osteoporosis documented in their rehabilitation medical record. Additionally, 66% of patients discussed or received osteoporosis management during outpatient primary follow-up appointments.