SAT-516 A Retrospective Review of Osteoporosis Diagnosis and Management at a VA Hospital

Abstract

Background - Osteoporotic fractures result in substantial morbidity and mortality, and they remain underdiagnosed and under-treated in men. Veteran Affairs (VA), the largest integrated health care system in the United States, predominantly treats males who are >50 years of age. Veterans have higher prevalence of obesity, smoking, inactive lifestyles, and comorbid conditions and thus are at a higher risk for osteoporosis compared to the general population. An increasingly aging population with an expected increase in incidence of fracture over the next 25 years, poses a huge financial burden. We present a retrospective review of osteoporosis care in the VA Nebraska Western Iowa healthcare system (NWIHCS) Rationale - The aim of the study is to identify VA patients in the NWICHS, with fragility fractures and determine how many are: 1) Diagnosed with osteoporosis, 2) Received bone density scans, 3) Started on calcium and/or Vitamin D and 4) Treated with bisphosphonates. Long term objective is to improve osteoporosis diagnosis and treatment in the inpatient and outpatient setting. Method- Retrospective chart review of patients in the NWIHCS. Inclusion criteria includes patients ≥ 50 years with diagnosis of a fragility fracture based on ICD-9 and 10 codes , including osteoporosis, pathological, vertebral/pelvis/femur neck and other parts of femur fractures from Jan 1, 2012-December 31, 2016. Results- Descriptive and nonparametric statistics were used to describe the data. 23 people met the criteria, 17 Males, 6 Females, median age 78 years, and BMI 25kg/m2. 6 were acutely treated in an inpatient VA setting and 17 had a previous fracture noted at a VA visit .15 patients had follow up at the VA within 2 years of fracture, of which 12 were started on osteoporosis medication and 9 on vitamin D and calcium. 9 patients had DEXA scans done with median T score at all regions of interest ≥ -2.5. Conclusion - Fractures are associated with chronic pain, disability, and decreased quality of life. Based on previous data only 24 % of veterans with fragility fractures receive appropriate care. In our review preliminary data found of 23 patients with fragility fractures and osteoporosis, only half had follow up, and fewer were treated appropriately with calcium, vitamin D and bisphosphonates. The Key is to identify and implement optimal strategies for the prevention and treatment of osteoporosis in veterans.