BACKGROUND: Recognition of incidental vertebral fractures may be an important opportunity for identifying and treating osteoporosis. OBJECTIVE: To assess osteoporosis documentation rates in patients with vertebral fractures, and to define patient and hospitalization characteristics associated with osteoporosis management. DESIGN: Hospital and outpatient records were abstracted for patients with vertebral fractures on inpatient radiograph reports. The primary outcome of interest was discharge summary fracture documentation. Covariates associated with fracture documentation and treatment were examined with multivariate regression models. Secondary outcomes included osteoporosis documentation and management 6 months following discharge. PATIENTS: Women > or =50 years hospitalized at an academic medical center. RESULTS: Among 10,291 women with chest radiographs, 142 (1.4%) had vertebral fractures reported. Among patients with a reported fracture, 58 (41%) had their fracture noted in the findings section but not in the final impression. Only 23 (16%) discharge summaries documented a vertebral fracture. Factors associated with documentation of the fracture in the discharge summary included notation of the fracture in the impression section (odds ratio [OR] 3.7, 95% confidence interval [CI] 1.0 to 13.1), tobacco use (OR 3.7; 95% CI 1.1 to 12.2), discharge from a medical service (OR 7.6; 95% CI 0.9 to 66.2) and glucocorticoid use (OR 3.7; 95% CI 0.8 to 17.0). Only 36% of patients were using any osteoporosis medications at discharge. Fracture notation in the impression section was associated with fracture documentation in subsequent outpatient notes (OR 3.6, 95% CI 0.9 to 13.8). Discharge summary fracture documentation was associated with an increased likelihood of starting an osteoporosis medication by 6 months (OR 2.8; 95% CI 0.8 to 9.2). CONCLUSIONS: Incidental vertebral fractures from inpatient chest radiographs may represent a missed opportunity for osteoporosis management.
BACKGROUND: Recognition of incidental vertebral fractures may be an important opportunity for identifying and treating osteoporosis. OBJECTIVE: To assess osteoporosis documentation rates in patients with vertebral fractures, and to define patient and hospitalization characteristics associated with osteoporosis management. DESIGN: Hospital and outpatient records were abstracted for patients with vertebral fractures on inpatient radiograph reports. The primary outcome of interest was discharge summary fracture documentation. Covariates associated with fracture documentation and treatment were examined with multivariate regression models. Secondary outcomes included osteoporosis documentation and management 6 months following discharge. PATIENTS: Women > or =50 years hospitalized at an academic medical center. RESULTS: Among 10,291 women with chest radiographs, 142 (1.4%) had vertebral fractures reported. Among patients with a reported fracture, 58 (41%) had their fracture noted in the findings section but not in the final impression. Only 23 (16%) discharge summaries documented a vertebral fracture. Factors associated with documentation of the fracture in the discharge summary included notation of the fracture in the impression section (odds ratio [OR] 3.7, 95% confidence interval [CI] 1.0 to 13.1), tobacco use (OR 3.7; 95% CI 1.1 to 12.2), discharge from a medical service (OR 7.6; 95% CI 0.9 to 66.2) and glucocorticoid use (OR 3.7; 95% CI 0.8 to 17.0). Only 36% of patients were using any osteoporosis medications at discharge. Fracture notation in the impression section was associated with fracture documentation in subsequent outpatient notes (OR 3.6, 95% CI 0.9 to 13.8). Discharge summary fracture documentation was associated with an increased likelihood of starting an osteoporosis medication by 6 months (OR 2.8; 95% CI 0.8 to 9.2). CONCLUSIONS: Incidental vertebral fractures from inpatient chest radiographs may represent a missed opportunity for osteoporosis management.
Authors: R M Neer; C D Arnaud; J R Zanchetta; R Prince; G A Gaich; J Y Reginster; A B Hodsman; E F Eriksen; S Ish-Shalom; H K Genant; O Wang; B H Mitlak Journal: N Engl J Med Date: 2001-05-10 Impact factor: 91.245
Authors: R Lindsay; S L Silverman; C Cooper; D A Hanley; I Barton; S B Broy; A Licata; L Benhamou; P Geusens; K Flowers; H Stracke; E Seeman Journal: JAMA Date: 2001-01-17 Impact factor: 56.272
Authors: Ian R Reid; Jacques P Brown; Peter Burckhardt; Zebulun Horowitz; Peter Richardson; Ulrich Trechsel; Albert Widmer; Jean-Pierre Devogelaer; Jean-Marc Kaufman; Philippe Jaeger; Jean-Jacques Body; Maria Luisa Brandi; Johann Broell; Raffaele Di Micco; Andrea Riccardo Genazzani; Dieter Felsenberg; Joachim Happ; Michael J Hooper; Jochen Ittner; Georg Leb; Hans Mallmin; Timothy Murray; Sergio Ortolani; Alessandro Rubinacci; Maria Saaf; Goran Samsioe; Leon Verbruggen; Pierre J Meunier Journal: N Engl J Med Date: 2002-02-28 Impact factor: 91.245
Authors: N Kim; B H Rowe; G Raymond; H Jen; I Colman; S A Jackson; K G Siminoski; A M Chahal; D Folk; S R Majumdar Journal: AJR Am J Roentgenol Date: 2004-02 Impact factor: 3.959
Authors: Saskia van Vugt; Lidewij Broekhuizen; Nicolaas Zuithoff; Pim de Jong; Christopher Butler; Kerenza Hood; Samuel Coenen; Herman Goossens; Paul Little; Jordi Almirall; Francesco Blasi; Slawomir Chlabicz; Mel Davies; Maciek Godycki-Cwirko; Helena Hupkova; Janko Kersnik; Arthur Mierzecki; Sigvard Mölstad; Michael Moore; Tom Schaberg; An De Sutter; Antoni Torres; Pia Touboul; Theo Verheij Journal: Ann Fam Med Date: 2012 Nov-Dec Impact factor: 5.166