The extent of diagnosis and treatment of osteoporosis in a Veterans Affairs population undergoing vertebral augmentation.

Abstract

To investigate whether patients with vertebral fracture who underwent an augmentation procedure had pre- or postaugmentation osteoporosis evaluation and treatment. Retrospective chart review. An academic, tertiary Veterans Affairs Medical Center with an active osteoporosis program, easy access to bone density testing by dual energy x-ray absorptiometry (DEXA), few barriers to treatment, and an excellent electronic medical record. After patients who underwent vertebroplasty for a traumatic or pathologic fracture were excluded, 40 patients were identified who had the procedure during a 1.5-year period. Most patients were older white men. Assessment of which patients had evaluation of underlying bone disease (with DEXA and 25-hydroxyvitamin D levels) and whether it was treated (with pharmacologic therapy). About 75% had a DEXA, but only half had the DEXA before the augmentation procedure. Fifty-five percent had the diagnosis of osteoporosis or osteopenia in the electronic record, and 60% had a serum 25-hydroxyvitamin D level usually before the procedure. Those patients who were referred to a metabolic bone clinic were more likely to have diagnostic tests and therapy. As with hip fracture, low-trauma vertebral fracture treated by an augmentation procedure should lead to osteoporosis evaluation and therapy.