POS0074 VERTEBRAL COMPRESSION FRACTURES AND OSTEOPOROSIS: RECOGNITION AND AWARENESS IN THE EMERGENCY DEPARTMENT AND INPATIENT SETTINGS
Authors: A. Minalyan, T. Li, K. D’anna, N. Alfraji, A. Blackburn, C. Downey
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Vertebral compression fractures (VCFs) are the most common osteoporotic fractures, accounting for an estimated 700,000 cases annually per year in the United States. Unfortunately, only ⅓ of patients with VCFs are clinically diagnosed. In many instances, medical providers fail to recognize osteoporotic fractures on radiology reports which results in delay in secondary prevention of osteoporotic fractures. At Loma Linda University Hospital (LLUH), the Division of Rheumatology initiated the Fracture Liaison Service (FLS) in 2017 aimed at improving osteoporosis management for patients admitted to hospital with osteoporotic fractures. <h3>Objectives:</h3> (1) To assess the level of osteoporosis awareness among medical providers for patients presenting to the emergency department (ED) as well as in hospitalized patients; (2)To estimate the rate of FLS consults or referrals to primary care providers (FLS/PCP) by primary medical teams in above-mentioned settings. <h3>Methods:</h3> A centralized radiology report archival system ("Montage Analytics") was used to examine all thoracic and lumbar spine computed tomography (CT) scans conducted between June 1, 2017 and June 1, 2022. A total of 449 studies were identified for patients aged 50 or greater who presented to the ED or were hospitalized with the impression of the radiologic report including the phrase "compression fracture". A manual chart review was performed to ascertain CT findings for each exam. In total, 182 studies were excluded based on the following criteria: (a) 32 - "no compression fracture" on report, (b) 48 - bone malignancy, (c) 5 - osteomyelitis, (d) 10 - transfer to outside hospital, (e) 6 - hospice/expired, (f) 20 - post-traumatic, including accidents, (g) 61 - concurrent lumbar and thoracic scans within the same hospitalization. Chi-tests were applied to assess all categorical variables (sex, language, race, reason for hospitalization, duration of hospitalization, etc.). A Welch t-test was used for quantitative variables, including age, duration of hospitalization. A 95% confidence interval and a p-value of &lt; 0.05 were used to determine statistical significance. <h3>Results:</h3> In total, 267 hospitalizations/ED visits with lumbar and/or thoracic spine CT scans were included (248 unique patients). Among these, 13 patients had more than one hospitalization/ED visit during the study period: 9 patients had 2 encounters; 2 patients had 3 encounters, and 2 patients had 4 encounters. Out of the 267 encounters, referrals to FLS (26) or PCP (27) were made in 53 cases (~20% of the total). Male encounters accounted for 97 cases (36%). The age, duration of hospitalization, BMI, primary language, race, reason for hospitalization, and patient disposition were comparable between the two groups (FLS/PCP vs no FLS/PCP). There was a difference in the distribution of primary team between the two groups (p=0.042) Notably, in the ED subgroup (131 hospitalizations), only 17 patients had FLS/PCP referrals. In terms of documentation, "compression" fracture was mentioned in 227 (85%) discharge notes (any part), while "osteoporosis" was mentioned in only 74 (28%) hospitalizations. A statistically significant difference was found between the two groups when "osteoporosis" was mentioned in the "Assessment and Plan" section (p=0.02) (Table 1). An overall trend of hospitalizations with compression fractures in the thoracic and lumbar spine, as well as the rate of FLS/PCP referrals during the study period, was also assessed (Graph 1). <h3>Conclusion:</h3> Our data show a concerning trend where, despite the indications of "compression fracture" in the impression of CT reports, the overall osteoporosis care for affected patients (both ED visits and hospitalized) is suboptimal. Medical providers often overlook the presence of osteoporosis, leading to a lack of consultation with the FLS of referral to PCPs for further evaluation and treatment. We suggest that implementing alert systems within electronic medical software could potentially improve the care of patients with vertebral compression fractures. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>