Programme no. 258-P
Secondary screening for osteoporosis in general practice
Andreas Kakulidis Toft*1, Janus Laust Thomsen2, Peter Vestergaard3, Marie Bjerg4, Martin Bach Jensen5
1Research Unit for General Practice in the North Denmark Region and Department of Clinical Medicine, Aalborg University,Aalborg,Denmark, 2Research Unit of General Practice and DAK-E,Odense C,Denmark, 3Endocrinology,Department of Clinical Medicine, The Faculty of Medicine, Aalborg University Hospital,Aalborg,Denmark, 4Research Unit for General Practice in the North Denmark Region and Department of Clinical Medicine, Aalborg University,Aalborg,Denmark, 5Research Unit for General Practice in the North Denmark Region and Department of Clinical Medicine, Aalborg University,Aalborg,Denmark
* = Presenting author
Objectives: To evaluate a screening and prevention program where patients identified as having an increased risk of osteoporosis were invited to come for a further osteoporosis and fall risk assessment, prevention advice, and referral to a DXA-scan.
Background: Osteoporosis is common and osteoporotic fractures are a major cause of suffering, increased mortality, and are very costly. Patients at increased risk of osteoporosis may be identified by using routinely gathered information in the electronic medical record e.g. those with a diagnosis of smoking, chronic obstructive pulmonary disease (COPD), underweight, hyperthyroidism, etc. Risk patients may then be advised about fall and osteoporosis prevention and offered a DXA-scan to establish whether they have osteoporosis, osteopenia or normal bone mineral density (BMD). In case of osteoporosis, patients should be offered further evaluation and treatment.
Results: In all 367 patients were identified as having one or more risk factors for osteoporosis. Eighty-five patients were excluded, 282 patients were invited to participate, 87 (31% of invited) had a fall and osteoporosis preventive consultation, and 74 patients have been scanned (13 pending). Out of 74 patients scanned, 16 had osteoporosis (22%), 36 had osteopenia (48%) and 22 (30%) had normal BMD. Of the 16 patients with osteoporosis, 10 (63%) had the risk factor COPD. The patient related costs were estimated to be approximately € 17.000. The main cost was DXA-scans (€ 160 per scan). Participating patients and health care professionals gave the study very positive evaluations.
Material/Methods: Two general practices in Aalborg, Denmark, with 9208 listed patients participated. January 2014 patients with an osteoporosis risk factor were identified. Excluded were patients with osteoporosis, < 25 years, DXA-scan ≤ 3 years and/or other cause contradicting participation. Eligible patients were invited, informed about the study, got at questionnaire regarding risk factors, and were invited to a preventive consultation. During this consultation risk factors were discussed and advice was given regarding fall prophylaxis, diet, vitamin D, etc. The patients’ medication was also evaluated. All patients were the offered referral to a DXA-scan.
Conclusion: A program for identification of patients at increased risk of osteoporosis was positively evaluated by patients and health care professionals. Approximately 1/3 of invited patients came for a preventive consultation and of those scanned 22% had osteoporosis. The price of giving preventive advice was low.
Points for discussion: Should we implement a program for identification of patients at increased risk of osteoporosis?