Osteoporosis Screening and Education in Community Pharmacies Using a Team Approach

Abstract

Study Objectives. To develop a model for osteoporosis screening and education in community pharmacies using a team approach, compare bone mineral density T-scores between quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DXA), and determine patient satisfaction with this pharmacist-provided osteoporosis screening and education program. Design. Prospective, cross-sectional study. Setting. Community pharmacies and outpatient family medicine, internal medicine, and obstetrics and gynecology clinics in Amarillo, Texas. Patients. Women aged 55 years or older with no previous diagnosis of osteoporosis or osteopenia who had at least one additional risk factor for osteoporosis and had not been screened in the previous 3 years. Intervention. Patients were referred from family medicine, internal medicine, and obstetrics and gynecology clinics to a community pharmacy. Osteoporosis screening using heel QUS and education regarding disease prevention and treatment were provided by pharmacists. Screening results, recommendations for confirmatory DXA, and potential treatments options were provided to the referring physicians. Measurements and Main Results. A total of 100 patients (mean age 66.2 + 7.9 yrs) were enrolled in the study; three were subsequently excluded. Of the 97 study patients who were screened using QUS, 45 (46%) patients were at moderate risk (T-score < −1 to > −2.5) and nine (9%) were at high risk (T-score ≤ −2.5). Of 54 patients recommended for DXA referral, 20 (37%) completed the scan. All 20 were diagnosed with either osteopenia (9 patients [45%]) or osteoporosis (11 patients [55%]). Correlation was moderate between T-scores obtained by QUS and DXA of lumbar vertebrae 1–4 (r=0.45, p=0.026). Counseling regarding risk factors, screening results, smoking cessation, calcium intake, exercise, and caffeine intake was perceived by patients as valuable or highly valuable (medians for all items ranged from 4–5 on a 5-point Likert scale). Of 84 patients assessed (13 were lost to follow-up), 81 (96%) said they would recommend this service to others. Conclusion. Osteoporosis screening and education in community pharmacies are effective in detecting undiagnosed disease and are perceived by patients as highly useful.