2025 Southeastern Residency Conference

Title: Evaluating the impact of a pharmacist-driven osteoporosis screening and treatment program in women veterans at the Birmingham VA Health Care System (BVAHCS)



Authors: Sara Chirambo; Lisa Ambrose



Objective: 
The purpose of this quality improvement project is to evaluate the effectiveness of
pharmacist-led interventions using the VA Osteoporosis Screening Dashboard to enhance the
identification of osteoporosis/osteopenia in patients seen in the Women's Health clinic at BVAHCS.


Self Assessment Question: 
What is the impact of pharmacist intervention in osteoporosis screening?


Background:  
Osteoporosis is a common chronic bone disease characterized by low bone mass and
deterioration of bone structure. It predominantly affects women, with higher prevalence
compared to men. Bone mineral density (BMD) peaks in early adulthood and declines with
age, increasing fracture risk. The USPSTF and National Osteoporosis Foundation recommend
routine screening for women aged 65 and older, typically using dual energy x-ray
absorptiometry (DEXA). Despite guideline recommendations, screening rates for osteoporosis
remain low. This project aims to evaluate whether the use of the VA Osteoporosis Screening
Dashboard by pharmacists improves identification of osteoporosis/osteopenia at the Birmingham VA.




Methods:
- Patients without a DEXA scan will be identified via the VA Osteoporosis Screening Dashboard
- Patients identified on dashboard will be reviewed and eligibility will be confirmed via chart review
- Pharmacists will communicate screening recommendations with patient 
- Pharmacists will place order for DEXA scan with patient consent
- DEXA scan will be scheduled through Medical Support Assistants (MSAs) at the Birmingham VA
- Pharmacists will contact patients to discuss DEXA/FRAX results and counsel patients on lifestyle modifications to reduce risk of osteoporosis. If patients are confirmed to have osteoporosis/osteopenia, treatment will be initiated by PharmD provider


Inclusion Criteria:
- Women aged 65 years and older
- No prior history of receiving DEXA scan in Computerized Patient Record System (CPRS)
- Patients followed by a provider in Women’s Health clinic


Exclusion Criteria:
- Patients currently receiving pharmacotherapy for osteoporosis or osteopenia
- Patients previously diagnosed with osteopenia or osteoporosis


Results:
The pharmacist-led osteoporosis screening initiative at the Birmingham VA Women's Clinic demonstrated a positive impact on patient care. 47/80 patients were reached by phone and of those 47, 33 patients were interested in a DXA screening. 57% patients reached who were interested scheduled a DXA scan. The pharmacist's outreach efforts, supported by the use of an osteoporosis dashboard created by the VISN7 VA Academic Detailing team resulted in an increase in screening rates compared to baseline. The intervention achieved a high patient acceptance rate, suggesting that direct pharmacist engagement encouraged participation.


Conclusion:
This quality improvement (QI) project highlights the value of pharmacist intervention in advancing preventative health measures within the VA healthcare system, specifically within women's health. By proactively identifying patients in need of screening and facilitating access to care, pharmacists played a role in increasing osteoporosis screening rates among older female veterans.