Clinical Pharmacists' Role in Improving Osteoporosis Treatment Rates Among Elderly Patients with Untreated Atraumatic Fractures

BACKGROUND: Missed opportunities for osteoporosis detection and treatment following fractures, especially in the elderly, are common. Clinical pharmacy specialist (CPS) intervention may positively impact this deficiency. OBJECTIVE: To examine the impact of a CPS-managed intervention to identify, screen, and initiate appropriate osteoporosis pharmacotherapy in elderly patients after an atraumatic fracture. METHODS: This was a prospective quality improvement analysis. Hospitalized and ambulatory patients who had a diagnosis of atraumatic fracture between July 2002 through August 2003 but were not on osteoporosis pharmacotherapy were identified by CPSs. Bone mineral density (BMD) screening and osteoporosis pharmacotherapy recommendations were made by a CPS when appropriate. Descriptive analyses were performed to determine the proportion of patients initiated on osteoporosis pharmacotherapy or receiving a recommended BMD evaluation. RESULTS: A total of 137 (40 inpatient and 97 ambulatory) female patients were included. The mean ages +/- SD of inpatient and ambulatory patients were 83 +/- 8 and 78 +/- 7 years, respectively. Overall, 50% (n = 69) of patients either initiated their recommended osteoporosis pharmacotherapy (48% [n = 19] and 30% [n = 29] of inpatient and ambulatory patients, respectively) or received a recommended BMD screening (42 ambulatory patients were recommended and 50% [n = 21] completed a BMD test). Of the patients who completed a BMD test, 17 (81%) were osteoporotic. All 17 were initiated on osteoporosis pharmacotherapy. CONCLUSIONS: Using a systematic approach to identify patients in need of osteoporosis pharmacotherapy, a CPS-managed intervention resulted in clinically meaningful osteoporosis treatment initiation rates.