Doctor of Nursing Practice (DNP) Projects

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Doctor of Nursing Practice

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Post Master's DNP Completion

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osteoporosis, bone density, DXA, screening, self-referral, older adults


Jeungok Choi, PhD, MPH, RN

DNP Project Outside Member Name

Sunita Hanjura, MD


Background: Osteoporosis is a prevalent condition that is often overlooked until a fragility fracture occurs. Screening for bone loss with dual-energy X-ray absorptiometry (DXA) scans is underutilized in the primary care setting. Direct communication with at-risk patients, offering self-referral for DXA screening, has been demonstrated to be the most effective intervention in increasing DXA screening rates.

Purpose: The goal of this DNP project was to improve bone density screening rates in a primary care practice by inviting patients at greatest risk of osteoporosis to schedule a DXA without a provider order.

Methods: After a review of the electronic medical record, letters and educational brochures were mailed to 261 eligible patients, including women age 50 and over and men age 70 and over, with instructions to schedule a DXA scan. Patients whose DXA results revealed osteoporosis or osteopenia with a high risk of fracture were invited for in-person educational counseling and medication management.

Results: Sixty-seven (25.6%) patients completed a DXA scan within three months of receiving the letter. Number of correct items on an abbreviated version of the Osteoporosis Knowledge Assessment Tool (OKAT) tool improved from 5.55 (SD 3.3) before counseling to 10.18 (SD = 2.2) after counseling. Three months after the intervention, 475 (66.3%) of patients in the practice were appropriately screened for osteoporosis, compared with 398 (55.6%) three months prior to the intervention.

Discussion: The implication for nurse practitioners is the need to advocate for primary and secondary prevention of osteoporosis as well as educate themselves about screening guidelines, lifestyle recommendations and medication options for treating osteoporosis.

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