Turner Naomi M, Mayeda Marissa Song, De Lima Bryanna, Friess Darin, Doung Yee-Cheen, Drago Kathleen
Oregon Health and Science University, Portland, Oregon.
J Bone Joint Surg Am. 2025 Apr 2;107(7):709-716. doi: 10.2106/JBJS.24.00766. Epub 2025 Feb 14.
Osteoporosis continues to be underdiagnosed and inadequately treated in older hip-fracture patients. Our aim was to improve the rate of osteoporosis treatment with IV bisphosphonate therapy in eligible patients admitted for hip-fracture surgery.
The present study was designed as a quality improvement initiative using Plan-Do-Study-Act (PDSA) cycles at an academic medical center in Portland, Oregon, over 2.5 years. A protocol was developed (1) to administer IV zoledronate on postoperative day 2 to inpatients aged ≥50 years who underwent surgery for a low-energy hip fracture and (2) to formally diagnose osteoporosis during admission. The protocol was introduced across 3 care settings in a stepped-wedge manner. Outcome measures were the percentage of inpatient zoledronate administered to eligible patients and formal documented diagnosis of osteoporosis. Balance measures included fever after administration and hospital length of stay (LOS). Measures were assessed through quarterly chart review and tracked via control charts.
The rate of zoledronate administration significantly increased from 34.5% (29 of 84) to 74.6% (53 of 71) following the second PDSA cycle (p < 0.001). Documented osteoporosis diagnosis also significantly improved from 51.0% (53 of 104) to 85.7% (96 of 112) following the second PDSA cycle (p < 0.001). No significant differences were shown for hospital LOS, and 1 of 82 patients had medical work-up for post-infusion acute phase reaction after administration.
This initiative was effective at improving osteoporosis diagnosis and treatment among older hip-fracture patients at our institution. Protocol development for administrating inpatient zoledronate after hip fracture is a reliable way to predictably offer bone health care and secondary-fracture prevention to hip-fracture patients and can be adapted and implemented at other institutions.
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
老年髋部骨折患者的骨质疏松症仍未得到充分诊断和治疗。我们的目标是提高接受髋部骨折手术的符合条件患者使用静脉注射双膦酸盐治疗骨质疏松症的比例。
本研究设计为一项质量改进计划，在俄勒冈州波特兰的一家学术医疗中心采用计划-实施-研究-改进（PDSA）循环，为期2.5年。制定了一项方案：（1）在术后第2天给年龄≥50岁、因低能量髋部骨折接受手术的住院患者静脉注射唑来膦酸；（2）在住院期间正式诊断骨质疏松症。该方案以逐步推进的方式在3个护理环境中推行。结果指标是符合条件患者接受静脉注射唑来膦酸的住院患者百分比以及正式记录的骨质疏松症诊断情况。平衡指标包括给药后的发热情况和住院时间（LOS）。通过季度病历审查评估各项指标，并通过控制图进行跟踪。
在第二个PDSA循环后，唑来膦酸的给药率从34.5%（84例中的29例）显著提高到74.6%（71例中的53例）（p<0.001）。记录的骨质疏松症诊断率在第二个PDSA循环后也从51.0%（104例中的53例）显著提高到85.7%（112例中的96例）（p<0.001）。住院时间没有显著差异，82例患者中有1例在给药后针对输注后急性期反应进行了医学检查。
该计划有效地改善了我们机构中老年髋部骨折患者的骨质疏松症诊断和治疗。制定髋部骨折后住院患者静脉注射唑来膦酸的方案是一种可靠的方法，可为髋部骨折患者提供可预测的骨骼保健和二次骨折预防，并且可以在其他机构进行调整和实施。
诊断性III级。有关证据水平的完整描述，请参阅作者指南。
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