Clinical Pathway Improves Screening and Treatment for Osteoporosis

Despite the high frequency of osteoporosis, it is still underdiagnosed and undertreated in many health care settings. However, a group of Belgium researchers may have developed a clinical pathway capable of improving the identification, referral, and treatment of osteoporosis in patients hospitalized due to low-impact fractures. 

During orthopedic ward rounds, the clinical pharmacist at Jan Brugge-Oostende AV (Bruges, Belgium) found osteoporosis had a low prevalence and that the screening and treatment of osteoporotic fractures was inconsistent. Therefore, after multidisciplinary discussions with orthopedic surgeons, the orthopedic ward doctor, geriatricians, rheumatologists, and endocrinologists, a clinical pathway was developed and implemented in 2013. 
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All adults admitted to the orthopedic surgery unit of the hospital with low-impact fractures were included in the pathway. These patients were referred to an osteoporosis specialist for medication reconciliation review, clinical evaluation, laboratory testing, and bone mineral density (BMD) measurement. Patients diagnosed with the disease were then given treatment to be initiated when deemed appropriate by the specialist. Patients were also given pamphlets with information about the pathway and advice on the proper intake of calcium and vitamin D. 

In a study published in the European Journal of Hospital Pharmacy, researchers led by Sofie Saey, Jan Brugge-Oostende AV, compared treatment practices for patients with low-impact fractures before and after the implementation of the clinical pathway for osteoporosis. 

Eighty patients were evaluated before the implementation of the pathway and 50 were reviewed after. Overall, patients treated on pathway had much more consistent and comprehensive screening than those not treated on the pathway. Prior to implementation, only 12% of patients received BMD screening, 90% of whom were diagnosed with either osteopenia (50%) or osteoporosis (40%). When the clinical pathway was implemented, BMD screening was performed in 64% of patients, 81% of whom were diagnosed with osteopenia (47%) or osteoporosis (34%).  

Further, the percentage of patients who were referred to a specialist grew from 14% to 80% after the implementation of the pathway, and 12% of patients had a planned consultation with an orthopedic surgeon or physician whereas none did prior to the pathway. In the group treated before pathway implementation, calcium and vitamin D supplements were started in 30% of the patients, whereas these supplements were initiated in 68% of patients in the group after implementation of the pathway. And an additional antiosteoporotic drug was started in 11% and 38% patients before and after the implementation of the pathway, respectively.

“After implementation of the clinical pathway, five times more patients underwent a BMD test,” authors of the study wrote. “Moreover, the number of patients receiving antiosteoporotic pharmacological treatment had doubled.”

They concluded that a clinical pathway for osteoporosis that is overseen by a clinical pharmacist could lead to better screening and treatment of osteoporosis.—Sean McGuire 

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Sofie S, Yves P, Barbara V, et al. Building for better bones: Evaluation of a clinical pathway in the secondary prevention of osteoporotic fractures [published online ahead of print September 6, 2016]. Eur J Hosp Phamr. doi:10.1136/ejhpharm-2016-000906.