Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Dr. Anne McKay

Second Advisor

Dr. Amy Manderscheid

Academic Year



Background and Objectives: Osteoporosis related fracture rates are high yet lack of screening and education on osteoporosis remains a significant problem. The United States Preventative Services Task Force (USPSTF) recommends bone mineral density testing in women ≥ 65 and in women aged 50-64, based on specific risk factors. Using a screening tool such as the simple calculated osteoporosis risk tool (SCORE) is beneficial in identifying individuals that should be referred for BMD testing. Screening for BMD using dual-energy absorptiometry (DXA) is the gold standard in predicting major fractures, allowing for timely intervention in the primary care setting. Consequently, a plan was developed using these tools to increase osteoporosis screening rates.

Methods: The quality improvement project was implemented using the Donabedian model for quality care at a rural primary care clinic in the Midwestern United States. Participants included office staff and eligible patients (women ≥ 50 years of age). A process was developed to screen individuals for osteoporosis using the SCORE tool in the electronic health record (EHR). A screening score of ≥ 6 indicated the need to refer for DXA. The QI project measures included: total number of patients screened, quantity of DXA referrals, completed DXA scans, and a pre/post-implementation staff survey.

Results: There was a statistically significant increase in the number of patients screened for osteoporosis risk in comparison to the pre-implementation period.

Conclusions: The process for osteoporosis screening improved screening rates.