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  • OSTEOPOROSIS & BONE HEALTH
  • POST-FRACTURE CARE
  • TOOLS FOR A SUCCESSFUL PFC PROGRAM
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Intended for US Healthcare Professionals

NEXT STEPS TO IDENTIFY, DIAGNOSE, AND MANAGE PATIENTS WITH OSTEOPOROSIS

Are you ready to share the medical evidence with your quality team?

The Health System Fracture Heat Map and ZIP Code Fracture Heat Map are interactive web tools that allow you to compare the prevalence of osteoporosis-related fractures and treatment at your health system with regional and national benchmarks.
  • Explore data across institutions
    in the United States
  • Explore data across your local
    geographical area
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Explore data across institutions in the United States

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Explore data across your local geographical area

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Quality measures from various organizations, including the National Quality Forum (NQF), the National Committee for Quality Assurance (NCQA), and The Joint Commission (JC), have been established to help improve osteoporosis management.

Learn more about osteoporosis quality measures

You Can Leverage Existing Technology Tools to Identify and Manage Patients

Electronic health record (EHR) systems can be used to help identify, investigate, and intervene with appropriate patients.1,2 Explore available resources to learn how EHR systems can help automate the systemic identification of patients with osteoporosis-related fractures to help improve patient care.

Click here to download EHR resources

Experts acknowledge that there is a decrease in the diagnosis and treatment of osteoporosis, even in patients who have suffered a fracture.3 A central DXA (dual-energy X-ray absorptiometry) scan can be used to diagnose osteoporosis before a broken bone occurs.4

Technologies may enhance patient identification initiatives by leveraging opportunistic screenings

  • Example: A patient receives a test (eg, an X-ray or a CT scan) for other reasons, from which a fracture is identified5
  • Example: Biomechanical CT scanning analyses can be used to identify patients with osteoporosis and patients at high risk for fracture6-8

CT=computed tomography.

Consider Clinical Pathways for Osteoporosis Management

Clinical pathways can help identify appropriate patients at risk for fragility fractures. They address patients in the pathway that have not been identified before treatment and those identified afterwards.9

Example of a bone health pathway for use before hospital discharge:

Group 332

Hypothetical Scenario9

A patient > 50 years of age presents with a low-trauma fracture.

Group 330

Lab Tests (Blood Test)9,10

In addition to basic laboratory tests, additional tests (eg, vitamin D level, calcium level, TSH and PTH) are conducted to assess for secondary causes of osteoporosis.

Group 366

Patient Education9

Before discharge, the patient and their family members are provided education on osteoporosis, allowing a shared involvement in the patient’s bone health. Proper education includes

  • Counseling to ensure adequate consumption of calcium and vitamin D
  • Physical therapy for gait training and balance
  • Importance of bone mineral density testing
  • Need to discuss osteoporosis medication with healthcare provider

Group 368

Primary Care Provider Follow-up9

Primary care providers ensure continuity of care for disease management and further evaluate the disease after the patient is discharged from the hospital. Considerations for follow-up appointments include but are not limited to

  • Bone density scan (DXA)
  • Management of osteoporosis medication
  • Follow-up of laboratory testing for possible secondary causes of osteoporosis
  • Follow-up on results of vitamin D test

Contact your account manager from Amgen and UCB for more information

Real-World Case Studies

Explore the real-world outcomes of organizations of various types, sizes, and locations that have implemented PFC programs.

  • Wake Forest Health System FLS
  • Own the Bone®
Mask Group 17

Wake Forest Health System FLS

In 2013, Wake Forest Health System established an orthopedic-managed FLS with a primary goal of reducing the risk of secondary fracture.11 The FLS implemented the 3 I’s to:11,*
  • Identify patients ≥ 50 years old with a fragility fracture on presentation to Wake Forest Health System emergency departments
  • Investigate PFC opportunity by referring patients through the EHR to a bone specialist at the osteoporosis clinic for workup, counseling, and treatment
  • Intervene with a set protocol to offer patients treatment plans and scheduled follow-up appointments

The FLS model has become incorporated into the methods of care provided at Wake Forest Health System.12 Patients are now captured at various points in the system, including primary care and other specialties as well as self-referrals.12

*For more information on the Wake Forest Health System FLS, please see article here.

Mask Group 17

Own the Bone®14

In 2009, the American Orthopaedic Association (AOA) launched Own the Bone® as a national quality-improvement program. The program’s goal is to provide tools and techniques for sites to use in real-world practice to enhance secondary fracture prevention.

From 2009 to 2016, the AOA conducted an investigation of the program to determine the percentage of patients in the program for whom anti-osteoporosis treatment was recommended or started at the time of initial evaluation. It also studied the association between the recommendation for osteoporosis treatment and a variety of patient and fracture variables.

The strongest associations between patient factors and likelihood of anti-osteoporosis treatment being recommended were:

Group 360Sedentary lifestyle (no ambulation or activity outside the home)
Group 330Parental history of hip fracture
The strongest associations between patient factors and the likelihood of anti-osteoporosis treatment being initiated were:
Group 353Prior fragility fracture
Group 330Parental history of hip fracture
Group 362Female sex
Group 357Vitamin D deficiency
Own the Bone® is a trademark of the American Orthopaedic Association.

Wake Forest Health System FLS

Mask Group 17

Wake Forest Health System FLS

In 2013, Wake Forest Health System established an orthopedic-managed FLS with a primary goal of reducing the risk of secondary fracture.11 The FLS implemented the 3 I’s to:11,*
  • Identify patients ≥ 50 years old with a fragility fracture on presentation to Wake Forest Health System emergency departments
  • Investigate PFC opportunity by referring patients through the EHR to a bone specialist at the osteoporosis clinic for workup, counseling, and treatment
  • Intervene with a set protocol to offer patients treatment plans and scheduled follow-up appointments

The FLS model has become incorporated into the methods of care provided at Wake Forest Health System.12 Patients are now captured at various points in the system, including primary care and other specialties as well as self-referrals.12

*For more information on the Wake Forest Health System FLS, please see article here.

Own the Bone®

Mask Group 17

Own the Bone®14

In 2009, the American Orthopaedic Association (AOA) launched Own the Bone® as a national quality-improvement program. The program’s goal is to provide tools and techniques for sites to use in real-world practice to enhance secondary fracture prevention.

From 2009 to 2016, the AOA conducted an investigation of the program to determine the percentage of patients in the program for whom anti-osteoporosis treatment was recommended or started at the time of initial evaluation. It also studied the association between the recommendation for osteoporosis treatment and a variety of patient and fracture variables.

The strongest associations between patient factors and likelihood of anti-osteoporosis treatment being recommended were:

Group 360Sedentary lifestyle (no ambulation or activity outside the home)
Group 330Parental history of hip fracture

The strongest associations between patient factors and the likelihood of anti-osteoporosis treatment being initiated were:

Group 353Prior fragility fracture
Group 362Female sex
Group 330Parental history of hip fracture
Group 357Vitamin D deficiency

Own the Bone® is a trademark of the American Orthopaedic Association.

Health systems can actively manage patients with osteoporosis at high risk for secondary fractures by implementing PFC programs tailored to their populations, based on their capabilities.1,13 Consider implementing a PFC program in your healthcare system

References: 1. Miller AN, Lake AF, Emory CL. Establishing a fracture liaison service: an orthopaedic approach. J Bone Joint Surg Am. 2015;97:675-681. 2. Feldstein A, Elmer PJ, Smith DH, et al. Electronic medical record reminder improves osteoporosis management after a fracture: a randomized controlled trial. J Am Geriatr Soc. 2006;54:450-457. 3. Hansen D, Pelizzari P, Pyenson B. Medicare cost of osteoporotic fractures. Accessed February 15, 2022. https://us.milliman.com/-/media/Milliman/importedfiles/ektron/medicare_cost_of_osteoporotic_fractures.ashx. 4. Bone Health & Osteoporosis Foundation website. Bone density exam/testing. Accessed February 15, 2022. https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/bone-density-examtesting/. 5. Akesson K, Marsh D, Mitchell PJ. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24:2135-2152. 6. ON Diagnostics. Fracture Risk Assessment. Accessed February 15, 2022. https://ondiagnostics.com/. 7. Lenchik L, Weaver AA, Ward RJ, Boone JM, Boutin RD. Opportunistic screening for osteoporosis using computed tomography: state of the art and argument for paradigm shift. Curr Rheumatol Rep. 2018;20:74. 8. Valentinitsch A, Trebeschi S, Kaesmacher J, et al. Osteoporos Int. 2019;30:1275-1285. 9. Wool NK, Wilson S, Chong ACM, Dart BR. Bone health improvement protocol. Kansas Journal of Medicine. 2017;10:62-66. 10. Camacho PM, Petak S, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract. 2020;26(suppl 1):1-46. 11. Scholten DJ, Bray JK, Wang KY, Lake AF, Emory CL. Implementation of a fracture liaison service and its effects on osteoporosis treatment adherence and secondary fracture at a tertiary care academic health system. Arch Osteoporos. 2020;15:80. https://doi.org/10.1007/s11657-020-00736-1. 12. Own the Bone. Success Stories. Accessed February 15, 2022. https://www.ownthebone.org/why-otb/success-stories/#1605891404128-4ecb5b94-2d61. 13. Capture the Fracture. What is a post fracture care coordination program (PFC)? Accessed February 15, 2022. https://www.capturethefracture.org/what-is-a-pfc. 14. Dirschl DR, Rustom H. Practice patterns and performance in U.S. fracture liaison programs. J Bone Joint Surg Am. 2018;100:680-685.

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  • OSTEOPOROSIS & BONE HEALTH
  • POST-FRACTURE CARE
  • TOOLS FOR A SUCCESSFUL PFC PROGRAM
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