Every ~20 seconds in the U.S a woman aged 50 or older suffers a fracture.1 These fractures result in higher rates of hospitalization than heart attack, stroke, or breast cancer, while having potentially life-altering consequences for patients.2,3,4
Despite increasing fracture rates, ~4 out of 5 postmenopausal women remain undiagnosed and untreated for osteoporosis one year after fracture.5,* To address this gap, health institutions need effective systems to follow up with and treat at-risk patients.
At Becker’s 12th Annual CEO + CFO Roundtable and in a new bone health podcast sponsored by Amgen, two experts shared insights from their successful post-fracture care programs.
Andrea Singer, MD, FACP, CCD, from MedStar Georgetown University Hospital, and Andrea Fox, DMSc, MMS, MHA, PA-C, from Stanford Health Care, sat down with Christen Buseman, PhD, director of IDN strategy and marketing for Amgen, to discuss strategies that have transformed patient care management at their institutions.
1) Taking a multidisciplinary approach
The traditional care journey often fails to provide appropriate treatment and education after a patient experiences a fracture.[6] This gap exists largely because it’s unclear which specialty should take responsibility for osteoporosis follow-up, according to Singer and Fox.
“Since osteoporosis doesn’t belong to any one specialty, the beauty of that is anyone can take charge. The other side of the sword is everybody thinks somebody else is going to take care of it,” Singer said.
To prevent patients from falling through the cracks, cross-specialty collaboration is crucial. At Stanford, Fox engaged with various teams to enhance referrals to the program and ensure comprehensive care.
She also highlighted how remote care advancements have expanded access for patients in areas lacking specialists.
2) Building a scalable foundation
After securing pilot funding to study post-fracture care follow-up rates at MedStar, Singer recognized the need for systemwide change. “We were following only 19% of people 50 years or older after a fracture,” she said during the conference.
She garnered support for a comprehensive post-fracture care program model now being scaled throughout the system, with established North and South regional programs. She achieved this by demonstrating the need, developing the service, building the team and establishing the business model. To lay the groundwork for a successful program, she noted that while scaling depends on a variety of factors, it’s critical to establish success metrics early so you can quantify the program’s impact for leadership.
3) Framing as a quality improvement initiative
“Making this a quality improvement project to align with hospital initiatives got the attention of the top administrators,” Fox said.
Fox told conference attendees that her team started the program by identifying the highest-risk patients coming into Stanford’s service lines.
The program evolved to focus on identifying, diagnosing and managing treatment as part of long-term chronic disease management, which is an important mindset to adopt, Fox said.
“We started with none of our trauma orthopedic hip fracture patients being referred for follow-up care, and now 86% of patients with hip fractures are referred to my program within six months,” Fox noted.
“These patients are so grateful for the care that they’re receiving and that there’s a program in place like this –they can’t believe it. They’re 82 years old coming in and they say, ‘No one has ever talked to me about my bones before.’”
To learn more about how health systems are working to improve post-fracture care programs, listen to our new podcast episode sponsored by Amgen featuring Andrea Singer and Andrea Fox.
* Data are from an anonymized patient claims dataset from IQVIA for women over age 50 diagnosed with or treated for osteoporosis, had a fragility fracture, or with at least one medical or pharmacy claim between January 2019 – December 2023. Fractures were counted if there was a diagnosis or procedure code for a fragility fracture of the hip, vertebra, femur, pelvis, humerus, radius/ulna, tibia/fibula, or clavicle. For patients with at least one fragility fracture between January 2019–December 2022, claims records were examined for post-fracture care, including the number of patients with a diagnosis code, DXA scan code, or a prescription for an osteoporosis treatment.
1 Data on file, Amgen, 2024.
2 Singer A, et al. Mayo Clin Proc. 2015; 90:53-62.
3 Cosman F, et al. Osteoporos Int. 2014; 25(10):2359-81.
4 Inacio MCS, et al. TPJ. 2015; 19(3):29-36.
5 Data on file, Amgen, 2024.
6 Bennett MJ, Center JR, Perry L. Exploring barriers and opportunities to improve osteoporosis care across the acute-to-primary care interface: a qualitative study. Osteoporos Int. 2023 Jul;34(7):1249-1262.
