title: Evaluation of osteoporosis risk and initiation of a nurse practitioner intervention program in an orthopedic practice.
abstract: The purpose of this study was to assess whether education and referral by a nurse practitioner could improve treatment adherence in patients with low bone mineral density in the orthopedic office. Our customized project did show some improvement but resistance to care continues in this unique population of patients.
  
  
  BACKGROUND
  Osteoporosis and osteopenia are significant clinical problems. Nearly 50% of adults over the age of 50 are osteopenic (Looker et al. in Osteoporos Int 22:541-549, 2011). Many patients with osteoporosis are not taking calcium or vitamin D, or any active treatment, even after dual energy X-ray absorptiometry (DXA) and demonstration of low bone mineral density (Dell et al. in J Bone Joint Surg Am 91(Suppl 6):79-86, 2009). One hypothesis to explain low adherence with osteoporosis treatment is lack of patient education. This study was designed to compare a control group with an education-intervention group (receiving patient education from a nurse practitioner) to determine any effect of education on treatment adherence.
  
  
  METHODS
  A total of 242 females and 105 males were studied as a control: a total of 292 females and 155 male were studied in the education group. Patients in the education group received educational materials and were counseled by a single nurse practitioner. Patients had a DXA performed and patients with osteoporosis or osteopenia were followed to assess treatment. At 12 months, patients received follow-up phone calls to determine patient use of calcium, vitamin D, and/or an active treatment. Results between the groups were compared.
  
  
  RESULTS
  Significantly more patients began calcium and vitamin D after education (p = 0.04); significantly more patients were taking or were recommended for an active treatment after education (p = 0.03). Thirty percent of patients either did not follow up or refused active treatment for osteoporosis. Approximately 50% of patients with osteoporosis were not taking an FDA-approved pharmacologic agent for osteoporosis treatment, despite education.
  
  
  CONCLUSIONS
  After patient education and referral to endocrinology, significantly more patients began calcium and vitamin D supplementation. However, up to 50% of patients with osteoporosis would not complete follow-up visits and/or did not adhere to treatment recommendations for osteoporosis.
authors: University Orthopaedic Associates, LLC, 2 World's Fair Drive, Somerset, NJ, 08873, USA. patricias@uognj.com.
authors: Patricia
authors: P
authors: Seuffert
authors: University Orthopaedic Associates, LLC, 2 World's Fair Drive, Somerset, NJ, 08873, USA.
authors: Carlos A
authors: CA
authors: Sagebien
authors: University Orthopaedic Associates, LLC, 2 World's Fair Drive, Somerset, NJ, 08873, USA.
authors: Matthew
authors: M
authors: McDonnell
authors: University Orthopaedic Associates, LLC, 2 World's Fair Drive, Somerset, NJ, 08873, USA.
authors: Dorene A
authors: DA
authors: O'Hara
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015519:Bone Density / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000451:nursing*; D002136:Calcium, Dietary / Q000627:therapeutic use; D016022:Case-Control Studies; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009722:Nurse Practitioners; D010024:Osteoporosis / Q000188:drug therapy / Q000451:nursing*; D058866:Osteoporotic Fractures / Q000451:nursing / Q000517:prevention & control; D010353:Patient Education as Topic / Q000379:methods; D012017:Referral and Consultation; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D014807:Vitamin D
keywords: Bisphosphonate; Bone mineral density; Calcium; DXA; Dual energy X-ray absorptiometry; Education; Fragility fracture; Osteopenia; Osteoporosis; Vitamin D