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Closing the Gap in Osteoporosis Risk Assessment for Smokers and High-Risk Alcohol Users in a General Practitioner
Basak Selin Kara1, Nidhi Sehgal2
1General Practice, Health Education East of England, Cambridge, GBR.
Cureus
|December 1, 2025
Summary
This quality improvement project successfully enhanced osteoporosis risk assessment in high-risk patients using systematic electronic health record searches and multidisciplinary team involvement. The initiative significantly improved Fracture Risk Assessment Tool (FRAX) documentation and dual-energy X-ray absorptiometry (DXA) scan rates in primary care.
Area of Science:
- Primary Care Medicine
- Quality Improvement in Healthcare
- Bone Health and Osteoporosis Management
Background:
- Osteoporosis poses a significant fracture risk, particularly in older adults with modifiable lifestyle factors.
- Identification and management of osteoporosis risk in high-risk groups within primary care settings require systematic approaches.
- Smokers and high-risk alcohol consumers over 50 represent a key demographic for targeted osteoporosis screening.
Purpose of the Study:
- To improve the identification, management, and documentation of osteoporosis risk in patients aged 50+ who smoke and consume excessive alcohol.
- To implement and evaluate a quality improvement project using the Plan-Do-Study-Act (PDSA) framework.
- To increase the rates of Fracture Risk Assessment Tool (FRAX) scoring and dual-energy X-ray absorptiometry (DXA) scanning in this high-risk cohort.
Main Methods:
- A three-cycle PDSA quality improvement project was conducted in a general practice.
- Eligible patients were identified through systematic electronic health record (SystmOne) searches.
- Interventions included FRAX scoring, patient outreach, pharmacist involvement, and electronic prompts within the EHR system.
Main Results:
- FRAX documentation increased from 2.05% at baseline to 100% post-intervention (p<0.001).
- DXA scanning rates for patients requiring assessment rose from 9.09% to 50% (p=0.0068).
- Among patients with DXA scans, diagnoses included osteoporosis (22.2%), osteopenia (55.6%), and normal bone density (22.2%).
Conclusions:
- Systematic quality improvement interventions significantly enhance osteoporosis risk assessment and management in primary care.
- Electronic health record integration and multidisciplinary team collaboration are effective strategies for improving bone health outcomes.
- Targeted QI initiatives can substantially improve fragility fracture risk assessment and preventive measures in high-risk populations.
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