Bone health in an upper Midwestern health system: Years 2008-2015

Osteoporosis, osteopenia, and low impact fractures have documented effects on morbidity and mortality. This study explores the prevalence of osteoporosis and osteopenia among United States patients referred for a DXA scan and profiles patients experiencing low impact hip fractures (LIHFs) in an Upper Midwestern program to improve treatment and prevent secondary fractures in these patients.

This retrospective observational study analyzed data from an in-house osteoporosis program database, trauma registry, and electronic health records. A DXA scan cohort included patients aged ≥50 years with completed DXA scans from 1/1/2008-9/30/2015. A LIHF cohort included patients aged ≥65 years receiving LIHF care from 1/1/2008-6/30/2015. Analyses included descriptive statistics, binary logit-linked generalized estimating equations, and survival analyses comparing mortality outcomes.

In total, 11,725 patients received a DXA scan during the study period, of whom 21.3 % had osteoporosis and 33.9 % had osteopenia. Of those with osteoporosis, 46.3 % were on osteoporosis medication six months after a DXA scan. Mortality rates were low in the DXA scan cohort. Of 1207 patients aged ≥65 years with LIHFs, 12.8 % received osteoporosis medication six months following the LIHF. The one-year mortality rate post-LIHF was 29.6 % across females and males. Mortality odds and hazards were significantly lower in those with DXA scans versus those with no DXA scan documented.

Opportunities to improve bone health management are achievable by enhancing recognition and treatment of patients at high risk for LIHFs, including those without prior DXA scans. Ongoing collaborative care supporting initiation of medication treatment following LIHFs is necessary.