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

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.