Osteoporosis Disease Management: Best Practices from the Penn State Geisinger Health System

Abstract

Osteoporosis is a common and costly systemic disease that affects an estimated 26 million women in the United States [1]. A 50-year-old white woman has a 40% chance of suffering an osteoporotic hip, wrist, or spine fracture during her lifetime [1]. The consequences of an osteoporotic hip fracture may include extended disability or death. The economic costs of osteoporosis are significant: nearly $14 billion was spent in 1995 to treat complications of the disease [2]. Strategies to diagnose and treat osteoporosis are available [3–8]. Bone mineral density (BMD) measurement can be used to reliably identify patients at risk for fracture [9,10]. Lifestyle modification (eg, exercise, smoking cessation), hormone replacement therapy, and several classes of medications have been shown to improve BMD and reduce fracture risk [3]. Given the prevalence of osteoporosis and its potentially serious consequences, the appropriate diagnosis and management of this disease should be high on the list of priorities for health care providers. In 1996, the Penn State Geisinger Health System (PSGHS) convened a multidisciplinary team consisting of representatives from rheumatology, endocrinology, general internal medicine, gynecology, orthopedics, radiology, nursing, pharmacy, biostatistics, and administration to develop a disease management program for osteoporosis. PSGHS is an integrated delivery system with 90 primary care sites serving 40 counties in central Pennsylvania. The Penn State Geisinger Health Plan (PSGHP) is one of the largest rural managed care plans in the country, with over 300,000 members and approximately 1000 employed or empanelled primary care physicians. A cost-benefit analysis based on prevalence data was undertaken that suggested that a comprehensive testing and treatment program for PSGHP enrollees could potentially result in a cost savings of $8 million over 5 years. This article will present the components of the program, the derived paradigms and projects, and program results to date.