Farid Pakizeh, Keyvan Mansouri
In this model, a structured osteoporosis alert in radiology reports was associated with substantially improved secondary fracture prevention processes. A publishable real-world study should pair the report wording intervention with explicit adherence auditing, EHR report-view tracking, time-to-action outcomes, and a fully specified interrupted time-series analysis.
UNLABELLED: A standardized osteoporosis alert in fracture radiology reports boosted osteoporosis care from 17 to 57% in 500 patients. This low-cost, scalable intervention bridges a critical communication gap between radiologists and clinicians, substantially improving secondary fracture prevention after fragility fractures.
BACKGROUND: Fragility fractures in adults aged 50 years or older are sentinel events for osteoporosis, but post-fracture evaluation and treatment remain inconsistent. Radiology reports are a scalable point of clinical communication, yet conventional fracture reports often describe morphology without explicitly recommending secondary fracture prevention.
PURPOSE: To evaluate whether an actionable osteoporosis alert embedded in musculoskeletal radiology reports improves downstream osteoporosis care after low-energy orthopaedic fractures.
METHODS: This multicenter interrupted time-series study included 500 adults aged 50 years or older with low-energy fractures treated across three centers: one academic trauma center, one academic general hospital, and one public community hospital. The pre-alert period included 250 patients from January to December 2024; the post-alert period included 250 patients from January to December 2025. The primary cohort included hip/proximal femur, clinical vertebral compression, distal radius/forearm, and proximal humerus fractures. Pelvic/sacral insufficiency fractures were retained only as an expanded secondary cohort. Low-energy fracture status was adjudicated from emergency, orthopaedic, and radiology documentation and defined as a fall from standing height or less without malignancy, periprosthetic fracture, atypical femoral fracture, or high-energy trauma. The intervention was a standardized report impression sentence recommending osteoporosis evaluation and secondary fracture prevention. The primary outcome was osteoporosis care initiation within 90 days, defined as DXA order, specialist/FLS referral, fracture-risk assessment, or anti-osteoporosis medication initiation.
RESULTS: In the expanded 500-patient cohort, actionable report wording increased from 6.8 to 82.4%. Overall radiologist adherence in the post-alert period was 206/250 reports (82.4%), varying by center from 71.7 to 88.4% and by fracture site from 66.7 to 91.4%. Osteoporosis care initiation increased from 16.8% before implementation to 56.8% after implementation. Segmented regression of 24 monthly observations demonstrated an immediate post-intervention level increase of 40.0 percentage points (95% CI, 33.0 to 47.0; p < 0.001), with no significant pre-intervention trend, no significant seasonality, and no evidence of positive autocorrelation (Durbin-Watson, 2.85). In multivariable analysis, the post-alert period remained associated with care initiation after adjustment for age, sex, fracture site, prior fragility fracture, glucocorticoid use, center, inpatient status, and baseline osteoporosis therapy.
CONCLUSION: In this model, a structured osteoporosis alert in radiology reports was associated with substantially improved secondary fracture prevention processes. A publishable real-world study should pair the report wording intervention with explicit adherence auditing, EHR report-view tracking, time-to-action outcomes, and a fully specified interrupted time-series analysis.