High-risk osteoporosis clinic (HiROC): improving osteoporosis and postfracture care with an organized, programmatic approach
Currently, it is unusual to combine evaluation for vertebral fracture with measurement of bone mineral density in clinical practice. Using Quantitative Morphometric Vertebral Analysis (Instant Vertebral Assessment [IVA]) in our existing Mobile Dual-Energy X-Ray Absorptiometry (DXA) Program, we implemented a testing procedure that examined 5 different IVA protocols focusing on clinical utility and cost. Using small-scale tests of change (PDSA cycles), data from the preceding cycle drives the development of the next cycle. In this article, we describe the process and rationale for selecting patients for the IVA study. In addition, we review the literature on vertebral fracture assessment using DXA and emphasize the clinical utility of point of service testing by providing the needed knowledge for best patient care by simultaneous DXA and IVA testing. The application of this new technology increased identification of the high-risk patient by 11%, with a nominal additional cost per DXA study of $14. This study provides a useful framework for the integration of IVA into a clinical DXA program.