RF06 | PSAT155 Are We Following the Recommendations to Screen for and Treat the "Silent Killer" in Our Geriatric Population? A Quality Improvement Project
Authors: Maradni Ahmad A , Correa Ricardo , Reddy Sandhya , Vinales Karyne 
Published: November 2022

Abstract

Introduction
Osteoporosis is characterized by weakening of the bone, disruption of its architecture, and loss of skeletal strength, leading to increased risk of fragility fractures. According to the CDC, the prevalence of osteoporosis in 2017-2018 was 5.7% in males and 17.7% in adults aged 65 and older. Approximately 2 million osteoporosis fractures occur annually in the USA. The annual direct cost is estimated to be $25.3 billion by 2025. Implementing effective strategies to help with early diagnosis, treatment, and follow-up is fundamental. Our study aims to identify barriers that render the geriatric population with osteoporosis from receiving optimal medical care.

Methods
We retrospectively reviewed a sample of 119 patients of a GERIATRIC PACT Veteran administration (VA) clinic between 1/1/2018 and 8/30/2021 to identify patients diagnosed with osteoporosis and monitor the adequacy of education, treatment, and follow-up. Possible treatment barriers and subsequent consequences were noted. Results were presented using descriptive statistics.

Results
The mean age of the cohort was 83±7 years old, 90% (N=107) of them being males, with a mean BMI and Hb A1c of 27± 6 kg/m2 and 6. 0± 2.1%, respectively. From the total, we obtained a sample of 17.8% (N=15, 12M/3F) patients who had a previous diagnosis of osteoporosis without concurrent medical management. Eight patients (53%) didn't have Osteoporosis management or discussion of the treatment with the clinician at their initial geriatric appointment, and 5 patients didn't discuss osteoporosis in subsequent visits either. Poor mental or physical status, limiting patient follow-up or treatment, was identified in 40%(N=6) of the patients. Adverse reactions were seen in 6.6% (N=1). 20% of the patient were on drug holiday (N=3), and 20% (N=3) refused any osteoporosis treatment. 26.6%(N=4) of the patients had developed fragility fractures. From this subgroup, one patient refused the treatment, and 3 had no osteoporosis treatment discussion at their initial visit.

Discussion
Our results showed that a significant number of patients with osteoporosis had no screening or evaluation. Osteoporotic fractures were presented within a few months in 20% of them. No identifiable cost barriers or contraindications to osteoporosis treatment were noticed. Multiple factors could have contributed to these events. Lack of universal clinical reminder for osteoporosis screening per national VA guidelines fails to identify men at increased risk for osteoporosis and it does not address the lack of follow-up reminders on this topic. Public misinformation regarding osteoporosis treatment is another barrier that needs to be addressed with education. Plans to identify patients with no concurrent treatment are necessary.

Conclusions
In geriatric veterans, implementing tools to follow-up on patients with osteoporosis and identifying treatment barriers is an essential step for high-quality, integrated, and comprehensive patient care. Such tools need to be validated with future studies to ensure effectiveness.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m.