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VBCR - December 2015, Volume 4, No 6 - ACR 2015
Alice Goodman

Implementation of a multidisciplinary bone health team (BHT) improved rates of screening, diagnosis, and treatment initiation for osteo­penia/osteoporosis in older veterans, compared with standard primary care. These were the findings of a large study conducted by the VA Salt Lake City Health Care System and the University of Utah.

According to the authors, this is the first report of a team-based intervention with the aim of improving management of osteopenia/osteoporosis in an older cohort of patients.

“We do a poor job of screening for osteoporosis/osteopenia. We need a systems-based approach to deal with this. Our system contracts with the primary care provider who signs up for management by the bone health team. The primary care practitioner assesses patients and sends at-risk patients notes about the need for bone scans, then follows up for results. This is paid for by the Centers of Innovation for VA Hospitals,” said lead author Karla Miller, MD, VA Salt Lake City Health Care System, Utah.

“It is not inexpensive to implement a bone health team, but it will save costs of care over time in preventing and delaying fracture,” she said.

An endocrinologist, a pharmacist, and an advanced nurse practitioner comprised the BHT. The study compared BHT management of patients at risk for fracture with that of standard management by a primary care practitioner.

The study cohort included 7644 at-risk individuals, 975 of whom were seen by the BHT and 6669 who were not. Participants were followed between February 2012 and February 2015. Male participants (97.8% of the cohort) were at least 70 years old, and females were 65 years of age or older.

Patients enrolled in the BHT initiative were significantly younger (P <.0001), more likely to live in a rural area (P <.0001), and more likely to have a physician as a primary care practitioner (P <.0001) compared with those not enrolled in the BHT intervention.

Outcomes included dual-energy x-ray absorptiometry (DXA) scan, laboratory tests, appropriate medications, and a diagnosis of osteopenia or osteoporosis. For each of these outcomes, a significant difference was observed favoring BHT versus standard primary care practice (P <.0001 for all comparisons).

A multivariate analysis adjusted for confounding factors such as age, sex, alcohol abuse, smoking, diabetes mellitus, prior adult fracture, hyperparathyroidism, renal disease, vitamin D deficiency, anticonvulsants, aromatase inhibitors, androgen-deprivation therapy, testosterone use, site of community-based outpatient clinic, and primary care practice discipline. In this analysis, people assigned to a BHT were 140% more likely to get DXA scans, 60% more likely to have laboratory tests, 17 times more likely to get appropriate medication, 37% more likely to have osteopenia diagnosed, and 16 times more likely to have osteoporosis diagnosed.

The authors believe that this approach to osteoporosis screening and management may offer an effective strategy for the primary prevention of osteoporotic fracture.

Reference

Miller KL, Grotzke MP, Lawrence P, et al. Implementation of a bone health team markedly improves osteoporosis screening, diagnosis and treatment initiation rates compared to standard primary care practice. Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 125.

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