Bone Health Improvement Protocol

Abstract

Introduction: Metabolic bone disease is a malady that causes significant morbidity and mortality to a patient who has sustained a fragility fracture. There is currently no protocol to prevent secondary fragility fracture at our institution. The objective of this study was to create an appropriate protocol for implementing clinical pathways for physicians to diagnose and treat osteoporosis and fragility fractures by educating patients.

Methods: A multidisciplinary team created an appropriate protocol that could be implemented in an inpatient setting. A thorough literature review was conducted to evaluate potential barriers and efficacious methods of protocol design.

Results: A bone health improvement protocol was developed. Any patient over the age of 50 who sustains a fracture from low energy trauma, such as a fall from standing or less, should be considered to place into this protocol. These patients received education on metabolic bone disease, a prescription for high dose vitamin D therapy, and laboratory testing to determine the etiology of their metabolic bone disease. Continuity of care of these patients with their primary care provider was provided for further management of their metabolic bone disease and evaluation of their disease after discharged from the hospital.

Discussion: Comprehensive secondary prevention should consist of osteoporosis assessment and treatment together with a fall risk assessment. With this protocol, secondary fragility fractures potentially could be prevented.

Keywords: bone fractures; metabolic bone disease; osteoporosis; secondary prevention.

Figure 1

The bone health protocol with treatment goals to be provided before the patient leaves the hospital.