Perspectives on pre-fracture intervention strategies: the Geisinger Health System Osteoporosis Program.

In its first decade, the goals of the Geisinger Health System Osteoporosis Program at its inception were to increase awareness, diagnosis, and treatment of osteoporosis and to monitor predefined outcomes. The program was innovative in that it crossed specialties and regions and used guidelines in an effective manner. In addition, success in reducing hip fracture and cost were demonstrated, and it remains one of the few programs today that has done so, as reported by Newman et al. (Osteoporos Int 14:146-151, 2003). The osteoporosis program has now moved from a provider and allied provider empowerment focus to reorganizing our thoughts about how to best manage osteoporosis care across our healthcare system by defining and acting on four major osteoporosis care gaps: (1) at-risk patients do not get tested, (2) tested patients are not accurately risk assessed, (3) high-risk patients do not get treated, and (4) treated patients are not adherent. Results of current internal programs and future steps are discussed.