Osteoporos Int (2014) 25 (Suppl 4):S503–S522 DOI 10.1007/s00198-014-2765-7
Interdisciplinary Symposium on Osteoporosis 2014 Patient-Centered Care: Developing Successful Bone Health Teams April 23–26, 2014 Sheraton New Orleans, New Orleans, LA, USA
ABSTRACTS
Osteoporosis International Vol. 25 Supplement 4 2013 DOI 10.1007/s00198-014-2765-7 This supplement was not sponsored by outside commercial interests; it was funded entirely by the Foundation’s own resources.
S504
Osteoporos Int (2014) 25 (Suppl 4):S503–S522
2014 INTERDISCIPLINARY SYMPOSIUM ON OSTEOPOROSIS
PROGRAM PLANNING COMMITTEE
Richard Dell, MD (Co-Chair) Kaiser Permanente Deborah T. Gold, MEd, PhD (Co-Chair) Duke University Medical School Susan Greenspan, MD University of Pittsburgh Steven T. Harris, MD, FACP University of California, San Francisco Cheryl Lambing, MD, FAAFP Ventura County Health Care Agency Susan Rawlins, RNC, WHNP National Association of Nurse Practitioners in Women’s Health Diane Schneider, MD, MSc University of California, San Diego Andrea Singer, MD Georgetown University Hospital Pamela Taxel, MD University of Connecticut Health Center Susan K. Randall, RN, MSN, FNP-BC National Osteoporosis Foundation – Lead Nurse Planner
Osteoporos Int (2014) 25 (Suppl 4):S503–S522
P1 IS HIP FRACTURE RISK ASSESSMENT INDEX (HFRAI), AN ELECTRONIC MEDICAL DATABASE DERIVED TOOL, COMPARABLE TO THE WORLD HEALTH ORGANIZATION FRACTURE ASSESSMENT TOOL (FRAX) IN SUBJECTS WITH KNOWN FEMORAL NECK BONE MINERAL DENSITY? Mohammad Albaba, M.D., Mayo Clinic, Rochester, MN; BACKGROUND We have recently derived and validated the Hip Fracture Risk Assessment Index (HFRAI) that uses electronic medical records data to predict hip fracture. HFRAI is computed automatically to provide the clinician with a readily available score to assess patient’s risk of hip fracture without obtaining FNBMD. We have found HFRAI to be comparable to the World Health Organization Fracture Assessment Tool (FRAX) in a cohort of subjects without known FNBMD. However, it is unknown whether the two indexes are alike when FNBMD is available. The goal of this study was to compare HFRAI to FRAX in subjects with known FNBMD. METHODS This was a historical cohort study. We randomly selected 850 community-dwelling adults over 60 years with known FNBMD who were enrolled in a primary care practice in Olmsted County, MN on 01/01/2005. We applied FRAX algorithm to obtain 10-year probabilities of hip fracture as of 01/01/2005. We created two receiver-operating curves (ROC), one ROC using the HFRAI scores at 01/01/2005, and the other using FRAX 10-year probabilities for hip fracture. The primary outcome was incident hip fracture in the subsequent 4 years. We computed the area under the curve (AUC) for each ROC. We used Z-test to compare AUCs. RESULTS On 01/01/2005 13,457 subjects over 60 years were enrolled in the practice. 94 % (12,650) consented to the study; among them 1953 subjects had FNBMD DXAscan within the previous 2 years. 34 of 850 subjects study group (4 %) sustained a hip fracture between 01/01/2005 and 12/31/2008. AUC for HFRAI was 0.78, which was no different than AUC for FRAX of 0.75 (p=0.43). CONCLUSION In our selected cohort HFRAI seemed to be a comparable tool to FRAX in hip fracture risk stratification in subjects with known FNBMD. The AUC trended higher for HFRAI but was no different than FRAX. Both tools integrate several clinical risk factors in risk stratification which may explain the similarity in our results.
S505
P2 HOSPITALIZATION BURDEN FOR OSTEOPOROTIC FRACTURE AND OTHER SERIOUS DISEASES IN OLDER US WOMEN Andrea Singer, MD FACP CCD, Medstar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC; Leslie Spangler, PhD, Amgen, Inc, Thousand Oaks, CA; Cynthia D. O’Malley, PhD, Amgen Inc, San Francisco, CA; Alex Exuzides, PhD, ICON, San Francisco, CA; Irene Agodoa, MD, Amgen Inc, Thousand Oaks, CA; Karissa Johnston, PhD, ICON, San Francisco, CA; Chris Colby, PhD, ICON, San Francisco, CA; Risa Kagan, MD, FACOG, CCD, NCMP, Sutter East Bay Physicians Medical Group and UCSF, Berkeley and San Francisco, CA; Background OP fractures, estimated to affect 50 % of women over age 50, are associated with decreased health-related quality of life, decreased mobility, placement in nursing homes, and even death. Yet, a qualitative study reports that women do not consider evidence of compromised bone health to be serious. Moreover, OP treatment rates, even after fracture, have declined during the past decade. This study compares the hospitalization burden of osteoporosis (OP) related fracture with that of other serious diseases experienced by postmenopausal women in the US. Methods Data from the 2000–2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) was used to estimate the number of US hospitalizations for postmenopausal women (age 55+) with a principal diagnosis, per ICD-09 code, of 1 of 4 serious diseases: OP fracture (hip, spine, humerus, wrist, forearm, pelvis, and femur), myocardial infarction (MI), stroke, or breast cancer. Inpatient costs (facility-related only; professional fees not included) were calculated for each inpatient stay using charge data and the NIS provided hospitalspecific cost-to-charge ratios. Costs were adjusted to 2011 USD using the Consumer Price Index. The average annual total inpatient hospital cost was calculated by multiplying the number of hospitalizations during 2008–2011 by the average cost for each condition. Results During the period 2000–2011, there were 11,379,040 hospital admissions in women age 55 and older for the four diseases combined; OP fracture (4.9 million), MI (2.9 million), stroke (3.0 million), and breast cancer (0.7 million). The number of hospitalizations for OP fracture was higher than any one of the other 3 disease conditions accounting for 43 % of the total hospitalizations for the 4 conditions combined over the 2000–2011 period; this percentage increased from 39 % in 2000–
S506
Osteoporos Int (2014) 25 (Suppl 4):S503–S522
2003 to 45 % in 2008–2011. Unlike MI, stroke, and breast cancer, OP fracture hospitalizations steadily increased during the study period. The annual total inpatient hospital cost (during 2008–2011) was highest for OP fracture ($5.9 billion USD), followed by MI ($4.0 billion), stroke ($3.3 billion), and breast cancer ($0.5 billion). Conclusion These data provide evidence that in older US women the hospitalization burden of OP fracture, as estimated by the number of hospitalizations and inpatient hospital cost, is greater than that of MI, stroke, or breast cancer. Prioritization of bone health and supporting programs, such as fracture liaison services, is needed to reduce this substantial burden.
P3 COORDINATION OF HOSPITAL AND PRIMARY CARE PROVIDERS TOWARD AN INTAGRATED SYSTEM OF OSTEOPOROSIS CARE Sofoclis Bakides, Director, Molaoi General Hospital, Molaoi, Greece; Stavroula Alevizou, Registrar, Molaoi General Hospital, Molaoi, Greece; John Bakides, Radiology Technician, Metaxa Hospital, Pireus, Greece; Charilila-Loukia Ververeli, Resident, Molaoi General Hospital, Molaoi, Greece; Kiriakos Drivas, Resident, Molaoi General Hospital, Molaoi, Greece; Maria Theochari, Resident, Molaoi General Hospital, Molaoi, Greece; Vasileios Kapagiannis, Resident, Molaoi General Hospital, Molaoi, Greece; George Sakellariadis, Director, Molaoi General Hospital, Molaoi, Greece; Angelos Charamis, Registrar, Molaoi General Hospital, Molaoi, Greece; George Papageorgiou, Director, Molaoi General Hospital, Molaoi, Greece;
AGE GROUP
40–49 (n=57) 50–65 (n=80) >65 (n=85) TOTAL (n=222)
T
Interdisciplinary Symposium on Osteoporosis 2014 Patient-Centered Care: Developing Successful Bone Health Teams April 23–26, 2014 Sheraton New Orleans, New Orleans, LA, USA
ABSTRACTS
Osteoporosis International Vol. 25 Supplement 4 2013 DOI 10.1007/s00198-014-2765-7 This supplement was not sponsored by outside commercial interests; it was funded entirely by the Foundation’s own resources.
S504
Osteoporos Int (2014) 25 (Suppl 4):S503–S522
2014 INTERDISCIPLINARY SYMPOSIUM ON OSTEOPOROSIS
PROGRAM PLANNING COMMITTEE
Richard Dell, MD (Co-Chair) Kaiser Permanente Deborah T. Gold, MEd, PhD (Co-Chair) Duke University Medical School Susan Greenspan, MD University of Pittsburgh Steven T. Harris, MD, FACP University of California, San Francisco Cheryl Lambing, MD, FAAFP Ventura County Health Care Agency Susan Rawlins, RNC, WHNP National Association of Nurse Practitioners in Women’s Health Diane Schneider, MD, MSc University of California, San Diego Andrea Singer, MD Georgetown University Hospital Pamela Taxel, MD University of Connecticut Health Center Susan K. Randall, RN, MSN, FNP-BC National Osteoporosis Foundation – Lead Nurse Planner
Osteoporos Int (2014) 25 (Suppl 4):S503–S522
P1 IS HIP FRACTURE RISK ASSESSMENT INDEX (HFRAI), AN ELECTRONIC MEDICAL DATABASE DERIVED TOOL, COMPARABLE TO THE WORLD HEALTH ORGANIZATION FRACTURE ASSESSMENT TOOL (FRAX) IN SUBJECTS WITH KNOWN FEMORAL NECK BONE MINERAL DENSITY? Mohammad Albaba, M.D., Mayo Clinic, Rochester, MN; BACKGROUND We have recently derived and validated the Hip Fracture Risk Assessment Index (HFRAI) that uses electronic medical records data to predict hip fracture. HFRAI is computed automatically to provide the clinician with a readily available score to assess patient’s risk of hip fracture without obtaining FNBMD. We have found HFRAI to be comparable to the World Health Organization Fracture Assessment Tool (FRAX) in a cohort of subjects without known FNBMD. However, it is unknown whether the two indexes are alike when FNBMD is available. The goal of this study was to compare HFRAI to FRAX in subjects with known FNBMD. METHODS This was a historical cohort study. We randomly selected 850 community-dwelling adults over 60 years with known FNBMD who were enrolled in a primary care practice in Olmsted County, MN on 01/01/2005. We applied FRAX algorithm to obtain 10-year probabilities of hip fracture as of 01/01/2005. We created two receiver-operating curves (ROC), one ROC using the HFRAI scores at 01/01/2005, and the other using FRAX 10-year probabilities for hip fracture. The primary outcome was incident hip fracture in the subsequent 4 years. We computed the area under the curve (AUC) for each ROC. We used Z-test to compare AUCs. RESULTS On 01/01/2005 13,457 subjects over 60 years were enrolled in the practice. 94 % (12,650) consented to the study; among them 1953 subjects had FNBMD DXAscan within the previous 2 years. 34 of 850 subjects study group (4 %) sustained a hip fracture between 01/01/2005 and 12/31/2008. AUC for HFRAI was 0.78, which was no different than AUC for FRAX of 0.75 (p=0.43). CONCLUSION In our selected cohort HFRAI seemed to be a comparable tool to FRAX in hip fracture risk stratification in subjects with known FNBMD. The AUC trended higher for HFRAI but was no different than FRAX. Both tools integrate several clinical risk factors in risk stratification which may explain the similarity in our results.
S505
P2 HOSPITALIZATION BURDEN FOR OSTEOPOROTIC FRACTURE AND OTHER SERIOUS DISEASES IN OLDER US WOMEN Andrea Singer, MD FACP CCD, Medstar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC; Leslie Spangler, PhD, Amgen, Inc, Thousand Oaks, CA; Cynthia D. O’Malley, PhD, Amgen Inc, San Francisco, CA; Alex Exuzides, PhD, ICON, San Francisco, CA; Irene Agodoa, MD, Amgen Inc, Thousand Oaks, CA; Karissa Johnston, PhD, ICON, San Francisco, CA; Chris Colby, PhD, ICON, San Francisco, CA; Risa Kagan, MD, FACOG, CCD, NCMP, Sutter East Bay Physicians Medical Group and UCSF, Berkeley and San Francisco, CA; Background OP fractures, estimated to affect 50 % of women over age 50, are associated with decreased health-related quality of life, decreased mobility, placement in nursing homes, and even death. Yet, a qualitative study reports that women do not consider evidence of compromised bone health to be serious. Moreover, OP treatment rates, even after fracture, have declined during the past decade. This study compares the hospitalization burden of osteoporosis (OP) related fracture with that of other serious diseases experienced by postmenopausal women in the US. Methods Data from the 2000–2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) was used to estimate the number of US hospitalizations for postmenopausal women (age 55+) with a principal diagnosis, per ICD-09 code, of 1 of 4 serious diseases: OP fracture (hip, spine, humerus, wrist, forearm, pelvis, and femur), myocardial infarction (MI), stroke, or breast cancer. Inpatient costs (facility-related only; professional fees not included) were calculated for each inpatient stay using charge data and the NIS provided hospitalspecific cost-to-charge ratios. Costs were adjusted to 2011 USD using the Consumer Price Index. The average annual total inpatient hospital cost was calculated by multiplying the number of hospitalizations during 2008–2011 by the average cost for each condition. Results During the period 2000–2011, there were 11,379,040 hospital admissions in women age 55 and older for the four diseases combined; OP fracture (4.9 million), MI (2.9 million), stroke (3.0 million), and breast cancer (0.7 million). The number of hospitalizations for OP fracture was higher than any one of the other 3 disease conditions accounting for 43 % of the total hospitalizations for the 4 conditions combined over the 2000–2011 period; this percentage increased from 39 % in 2000–
S506
Osteoporos Int (2014) 25 (Suppl 4):S503–S522
2003 to 45 % in 2008–2011. Unlike MI, stroke, and breast cancer, OP fracture hospitalizations steadily increased during the study period. The annual total inpatient hospital cost (during 2008–2011) was highest for OP fracture ($5.9 billion USD), followed by MI ($4.0 billion), stroke ($3.3 billion), and breast cancer ($0.5 billion). Conclusion These data provide evidence that in older US women the hospitalization burden of OP fracture, as estimated by the number of hospitalizations and inpatient hospital cost, is greater than that of MI, stroke, or breast cancer. Prioritization of bone health and supporting programs, such as fracture liaison services, is needed to reduce this substantial burden.
P3 COORDINATION OF HOSPITAL AND PRIMARY CARE PROVIDERS TOWARD AN INTAGRATED SYSTEM OF OSTEOPOROSIS CARE Sofoclis Bakides, Director, Molaoi General Hospital, Molaoi, Greece; Stavroula Alevizou, Registrar, Molaoi General Hospital, Molaoi, Greece; John Bakides, Radiology Technician, Metaxa Hospital, Pireus, Greece; Charilila-Loukia Ververeli, Resident, Molaoi General Hospital, Molaoi, Greece; Kiriakos Drivas, Resident, Molaoi General Hospital, Molaoi, Greece; Maria Theochari, Resident, Molaoi General Hospital, Molaoi, Greece; Vasileios Kapagiannis, Resident, Molaoi General Hospital, Molaoi, Greece; George Sakellariadis, Director, Molaoi General Hospital, Molaoi, Greece; Angelos Charamis, Registrar, Molaoi General Hospital, Molaoi, Greece; George Papageorgiou, Director, Molaoi General Hospital, Molaoi, Greece;
AGE GROUP
40–49 (n=57) 50–65 (n=80) >65 (n=85) TOTAL (n=222)
T
