The osteoporosis care gap is an all too real and emotionally and financially costly problem. Existing practice guidelines and program such as Own the Bone, Capture the Fracture provide a clear and thorough path to eliminate this gap. But for hospitals and health care systems that lack the time, buy-in, personnel, or coordination to carry them out, guidelines may feel overwhelming and inaccessible. Providers and administrators then default to standard care: treating the acute fracture, not the underlying cause.
We must narrow the gap between today’s reality and needed action. The key may be for hospitals to create (or add to) standing discharge orders for all geriatric fractures:
- Vitamin D and Calcium prescription
- Weight-bearing as tolerated
- a bone density test scheduled at six weeks
Standing discharge orders can be overridden if medically indicated, but ease provider burden by creating a highly usable default. Health care systems can easily absorb these particular orders. Vitamin D and Calcium are well-tolerated, inexpensive, and can be started before an osteoporosis diagnosis is confirmed. Weight-bearing as tolerated allows physical therapists to start evidence-based PT immediately, as opposed to a common post-fracture instruction: non-weight bearing.
Meanwhile, the DEXA scan can be key to confirming an osteoporosis diagnosis. Studies show better outcomes when the DEXA is ordered at the hospital versus through a primary care provider (PCP). Scheduling it for six weeks gives patient time to heal and allows a smoother handoff to the PCP for follow-up.
Finally, there need to be standing orders so that a nurse can provide quick patient education: the break happened for a reason, a reason that puts patients at risk for repeat fractures, but we are going to investigate the root cause, and provide treatment to prevent this from happening again.
Are these measures enough? No. But research suggests they are starkly better than nothing— and they are easy to implement. Perhaps more importantly, the orders allow a person to be identified as osteoporotic, thus activating the entire healthcare ecosystem so a host of other interventions may follow.