The Bone Health Team: A Team-Based Approach to Improving Osteoporosis Care for Primary Care Patients.

Abstract

Background: Significant improvements in secondary prevention of osteoporotic fractures have been noted with fracture liaison services. However, similar models for the primary prevention of such fractures have not been reported. Objective: To determine the impact of a Bone Health Team (BHT) on osteoporosis screening and treatment rates in U.S. veterans in primary care practices. Design: Historical cohort study of a primary care–based intervention of a BHT from February 2013 to February 2015. Setting: Community-based outpatient clinics of the Salt Lake City Veterans Affairs Health Care System. Participants: Men aged 70 years and older and women aged 65 years and older. Intervention: Enrollment in the BHT. Measurements: Rates of dual energy x-ray absorptiometry (DXA) completion, chart diagnosis of osteoporosis or osteopenia, completion of vitamin D measurement, and initiation of fracture reducing medication. Results: Our cohort consisted of 7644 individuals, 975 of whom were exposed to the BHT and 6669 of whom were not. Comparison of patients exposed to the BHT versus non-exposed subjects demonstrated a substantial increase in all outcome measures studied. Hazard ratios (HRs) from multivariable cox proportional hazard models were: measurement of vitamin D, HR = 1.619 (P < .001); chart diagnosis of osteopenia, HR = 37.00 (P < .001); chart diagnosis of osteoporosis, HR = 16.38 (P < .001); osteoporosis medication, HR = 17.03 (P < .001); and completion of DXA, HR = 139.9 (P < .001). Conclusions and Relevance: The implementation of a dedicated BHT produced significantly increased rates of intermediate osteoporosis outcome measures in US veterans in primary care practices. Additional research describing medication adherence rates and cost-effectiveness is forthcoming.