Healthcare Inspection Management of Osteoporosis in Veterans with Fractures

The VA Office of Inspector General Office of Healthcare Inspections assessed the extent to which Veterans Health Administration (VHA) patients who experience a fracture of the hip or vertebra are appropriately evaluated and treated for osteoporosis. We assessed compliance using guidelines from the Healthcare Effectiveness Data and Information Set (HEDIS) measure for post-fracture osteoporosis management. This measure accepts a bone-density scan or prescription for osteoporosis medication as evidence of osteoporosis management. We reviewed the medical records of patients whose management was found to be non-compliant to identify evidence of characteristics that would exempt their care from compliance expectations. During the study period, 1,413 patients met inclusion criteria. After adjustment for the presence of exemptions, compliance based on HEDIS criteria among patients with two or more VHA primary care visits in the prior year was 45 percent. Compared to women, men were less likely to be appropriately managed for osteoporosis after a fracture (OR 0.33. p .001). Hip fractures were less likely to be associated with osteoporosis management when compared with vertebral fractures (OR 0.39. p .001). One-year mortality after a fracture was 20.5 percent, 25.1 percent for hip fracture and 14.4 percent for vertebral fracture. We recommended that the Under Secretary for Health implement a plan to ensure that patients with hip or vertebral fracture are appropriately evaluated and treated for osteoporosis.