Fracture Risk Assessment and Osteoporosis Screening of Postmenopausal Women in Primary Care: A Quality Improvement Project

Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Julio Lujano


Background. Osteoporosis and risk of fragility fracture increase with age, often resulting in fracture-related disability, decreased quality of life, morbidity, and mortality. The available fracture risk and osteoporosis screening tools that promote early risk identification and subsequent fracture prevention are underutilized in primary care; opportunities to prevent progressive bone loss and fracture are often missed. Purpose. This project aims to improve the identification of postmenopausal women at risk of fragility fractures within a primary care setting. Objectives. Educate clinic staff on clinical risk factors of fragility fractures and osteoporosis. Facilitate communication of osteoporosis risk and prevention to patients. Establish the baseline fracture risk for postmenopausal women aged 50 to 75 years to improve the number of appropriately ordered bone density scans. Methods. A fracture risk questionnaire informed by current guidelines and recommendations was developed and integrated into a primary care clinic's current appointment process. The questionnaire was administered to postmenopausal women aged 50 to 75 years. Clinical risk factors were assessed to determine patients' fracture risk, guide preventive education, and inform clinical decisions on the appropriateness of bone density scans. Outcomes. A total of 177 eligible patients were seen during the 10-week project. Fracture risk was calculated on 41.81% of patients, 44.21% of patients screened received education on osteoporosis risk and prevention, and bone density scans increased to 57.58% from 11% baseline. Implications. A standardized process to assess fracture risk promotes appropriate osteoporosis screening and early identification of those who would benefit from treatment.

This document is currently not available here.