Fractures resulting from minimal trauma result in significant morbidity and mortality in the elderly. These fragility fractures are related to underlying osteoporosis. Each year, an estimated 1.5 million women, about 4 in 10, experience osteoporotic fractures in the U.S. Up to 20% of women with a hip fracture die within one year (National Osteoporosis Foundation, 2003). The number of new osteoporotic fractures exceeds the number of new cases of breast cancer and heart disease in patients older than 65 (American Heart Association, 1999; American Cancer Society, 2000). In the following focus study of elderly female patients living in the community, we found a high prevalence of undiagnosed and untreated osteoporosis.
The subject of the study was 257 elderly participants in the PACE CNY (Program of All-Inclusive Care for the Elderly) program. PACE CNY is one of 31 programs nationwide whose purpose is to maintain frail elderly people in their homes and/or the community by maximizing independence and functional ability. A team of healthcare professionals work together to coordinate all the services necessary to help the client manage in his or her home and surroundings successfully. Most participants are nursing home eligible; however, less than 10% actually require skilled-nursing facility (SNF) services.
The PACE CNY census is approximately 85% female and 15% male participants. All men were excluded from the study, as well as women under the age of 65, as they fell outside of the current U.S. Preventive Services Task Force (USPSTF) guidelines for osteoporosis screening.
The initial census in our study was 174 subjects. A chart review was performed on all study participants by the authors, and an informational letter was sent to participants and families informing them of our study. The study was conducted over 10 months and included active patients enrolled through March 30, 2003. At the initiation of the study, baseline data was collected. Charts were screened for an existing diagnosis of osteoporosis, a history of a fragility fracture, history of spinal compression fracture, and current treatment being provided for osteoporosis. World Health Organization (WHO) and National Osteoporosis Foundation (NOF) guidelines were utilized for screening and treatment decisions (Figure 1).