Initiative to Improve Osteoporosis Management by Adapting the Fracture Liaison Service for Outpatient Use
Tiffany Messerall, WHNP-BC, DNP Student; Callie Cheese, DNP, FNP-BC, WHNP-BC; Sarah King, WHNP-BC
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Purpose: To evaluate whether the implementation of the IOF Best Practice Framework in an outpatient women’s health clinic results in improved identification and management of post- menopausal women at risk of an osteoporotic fracture.
Summary: Fragility fractures in post-menopausal women are more common than stroke, myocardial infarction, and breast cancer combined. An osteoporotic fracture has a large impact on quality of life, the risk for subsequent fractures, and the risk of mortality. The number of fragility fractures are expected to increase as a result of the growing and aging population. However, despite known diagnostic and management modalities only 20% of women with a fragility fracture are screened, diagnosed, and treated for osteoporosis. For this quality improvement initiative, the IOF Best Practice Framework will be used to develop a Fracture Liaison Service (FLS) model to identify women at risk of a primary or subsequent fracture at an outpatient gynecology clinic. A protocol for standardized screening of fracture risk will be implemented in post-menopausal women 50 and above. In women with positive screens, the assessment of modifiable lifestyle factors and possible secondary etiologies will be addressed. A clinic-specific treatment algorithm will be created to guide clinicians using evidence-based medication treatment sequences. Local referral networks will be outlined.
Outcomes: Project implementation is ongoing. Data analysis will be completed in August 2019. Adherence to osteoporosis screening, assessment of lifestyle factors, activation of referral network, and initiation of medication therapy will be assessed via a convenience sampling chart review of 100 health records after 8 weeks of implementation.
Implications for Women’s Health: The osteoporosis treatment gap has been largely attributed to the lack of ownership by any single medical specialty. Women at risk for fragility fractures fail to be screened, diagnosed, and treated. Due to safety concerns with hormone therapy many post-menopausal patients are at an increased risk for osteoporosis. The FLS model has demonstrated improvement on mortality and subsequent fracture rates and can be adapted to any model of care. By examining a FLS model for outpatient gynecology, the women’s health care provider can demonstrate how to close the treatment gap for women under their care.
Fracture Liaison Service
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