SAT-777 - From Screening to Therapy: Implementing A Resident-Driven Osteoporosis "DXA-to-Treatment" Algorithm in A University of Kansas Internal Medicine Clinic

Background
Osteoporosis screening and treatment are frequently delayed in primary care, particularly in resident clinics where DXA follow-through and treatment initiation may be inconsistent. In our University of Kansas resident internal medicine clinic, screening occurred but abnormal DXA results were not reliably converted into timely pharmacologic therapy, creating a preventable fracture-risk gap.

Objective
To improve osteoporosis care by implementing a standardized, treatment-forward algorithm that increases DXA completion and reliably links abnormal DXA results to appropriate pharmacologic initiation.

Methods
We conducted a quality improvement initiative using sequential Plan-Do-Study-Act cycles in a resident continuity clinic. Eligible patients included females ≥65 years and males ≥70 years. Outcomes were measured using an EHR-generated osteoporosis screening and treatment report. The intervention was implemented in August 2024 and centered on a standardized “Identify, Investigate, Interpret, Initiate” osteoporosis algorithm that was integrated into the EHR and applied during annual wellness visits to standardize osteoporosis care. During those visits, residents were prompted to identify screening-eligible patients, investigate by ordering DXA with baseline labs, interpret results using guideline-based thresholds (osteoporosis: T-score ≤ −2.5 or fragility fracture; osteopenia treated if FRAX hip ≥3% or major osteoporotic fracture risk ≥20%), and initiate therapy at the point of diagnosis rather than deferring to subspecialty referral. Oral bisphosphonates were used as first-line therapy when appropriate, with an algorithm pathway for alternative options when oral therapy was unsuitable.

Results
One year after algorithm implementation, the number of eligible patients screened (DXA ordered) increased from 39 to 53, and DXA completion improved from 77% (30/39) to 85% (45/53). The proportion of patients with abnormal DXA results who were started on pharmacologic treatment increased from 60% prior to the intervention to 100% after implementation.

Conclusion
A standardized resident-driven osteoporosis algorithm integrated into the EHR and implemented during annual visits eliminated the treatment gap for abnormal DXA results and improved DXA completion in a resident clinic. Embedding an “Identify, Investigate, Interpret, Initiate” pathway into primary care training environments may strengthen osteoporosis management and reduce missed opportunities for fracture prevention.

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