| Course | DNP 704 Principles of Evidence-based Care in Advanced Practice |
|---|---|
| Module | Module 1 |
| Paper type | Background and significance literature review |
| Length | About 642 words, 5 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 704 Module 1
Broken Once, Untreated Twice: The Background and Significance of the Osteoporosis Treatment Gap After Fragility Fracture
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
DNP 704: Principles of Evidence-based Care in Advanced Practice
Instructor Name
Month Day, Year
Broken Once, Untreated Twice: The Background and Significance of the Osteoporosis Treatment Gap After Fragility Fracture
Introduction
A fragility fracture, a break from a fall from standing height or less, is often the first sign of osteoporosis. It is also the strongest warning that another fracture may follow. Yet in my orthopedic clinic, patients are usually treated for the broken bone and discharged without any plan for the bones that are not yet broken. This paper reviews the background and significance of that gap and develops a clinical question for an evidence-based practice project.
Scope of the Problem
Osteoporotic fractures are associated with psychological distress, subsequent fractures, loss of independence, reduced ability to perform daily activities, and death (US Preventive Services Task Force, 2025). Hip fractures carry the greatest burden, but wrist, vertebral and humeral fractures also signal elevated risk.
Despite effective treatments, use of osteoporosis medication after fracture is low and fell over time. In a U.S. claims study of nearly 97,000 adults aged 50 and older hospitalized for hip fracture, the estimated probability of osteoporosis medication use within 12 months of discharge was 28.5%, and rates fell from 40.2% in 2002 to 20.5% in 2011 (Solomon et al., 2014). Older age and male sex were associated with lower use. The strongest predictor of treatment after fracture was treatment before it, suggesting that fractures themselves rarely trigger a new treatment decision.
Guidelines and Position Statements
For primary prevention, the USPSTF recommends osteoporosis screening for women aged 65 and older and for postmenopausal women younger than 65 at increased risk, while finding insufficient evidence for screening men (US Preventive Services Task Force, 2025). Its recommendation applies to people without a prior fragility fracture, which highlights an important point: once a fragility fracture has occurred, the question is no longer screening but evaluation and treatment, and responsibility often falls between orthopedic, emergency and primary care clinicians.
Fracture Liaison Services as a System Solution
Fracture liaison services (FLS) assign a coordinator, often a nurse, to identify patients with fragility fractures, arrange bone density testing, start or recommend treatment and ensure follow-up. A systematic review of 57 high-quality studies found that FLS programs increased the likelihood of bone mineral density testing and treatment initiation compared with usual care, and that multidisciplinary involvement, a dedicated case manager, regular follow-up, interventions with several parts and patient education contributed to success (Wu et al., 2018). Meta-analyses have found lower rates of subsequent fracture with FLS care (Li et al., 2021).
Internal Practice Data
To see whether the gap applies locally, I reviewed 60 consecutive charts of adults aged 50 and older seen in our clinic for a wrist, humerus or ankle fracture caused by a fall from standing height over three months. Only 9 (15%) had a documented plan for osteoporosis evaluation, such as a referral for bone density testing or a recommendation to primary care, and 4 (7%) started treatment within six months. These results mirror the national gap.
Theoretical Perspective
The knowledge-to-action framework describes how knowledge moves into practice through a repeating cycle that runs from naming a problem and fitting evidence to the local setting, through barriers and chosen interventions, to monitoring and evaluation (Graham et al., 2006). The treatment gap is a classic knowledge-to-action problem: the evidence is clear, but no one in the current workflow owns the next step.
Significance for Practice
Closing the gap could prevent second fractures, reduce disability and costs, and give patients information they rarely receive. For a DNP-prepared nurse, the problem is ideal because it requires system redesign rather than new science.
PICOT Question
In adults aged 50 and older seen for a fragility fracture in an outpatient orthopedic clinic (P), does a nurse-coordinated fracture liaison service (I), compared with usual care (C), increase the proportion who start osteoporosis treatment (O) within six months of the fracture (T)?
References
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26(1), 13-24. https://doi.org/10.1002/chp.47
Li, N., Hiligsmann, M., Boonen, A., van Oostwaard, M. M., de Bot, R. T. A. L., Wyers, C. E., Bours, S. P. G., & van den Bergh, J. P. (2021). The impact of fracture liaison services on subsequent fractures and mortality: A systematic literature review and meta-analysis. Osteoporosis International, 32(8), 1517-1530. https://doi.org/10.1007/s00198-021-05911-9
Solomon, D. H., Johnston, S. S., Boytsov, N. N., McMorrow, D., Lane, J. M., & Krohn, K. D. (2014). Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. Journal of Bone and Mineral Research, 29(9), 1929-1937. https://doi.org/10.1002/jbmr.2202
US Preventive Services Task Force. (2025). Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA, 333(6), 498-508. https://doi.org/10.1001/jama.2024.27154
Wu, C.-H., Chen, C.-H., Chen, P.-H., Yang, J.-J., Chang, P.-C., Huang, T.-C., Bagga, S., Sharma, Y., Lin, R.-M., & Chan, D.-C. (2018). Identifying characteristics of an effective fracture liaison service: Systematic literature review. Osteoporosis International, 29(5), 1023-1047. https://doi.org/10.1007/s00198-017-4370-z
Reading the DNP 704 Module 1 assignment instructions
The posted syllabus describes four scaffolded papers that build toward the DNP project, worth 80% of the grade together, with four immersions worth 20%. Paper 1, Background and Significance, is an in-depth literature review that includes recent research, epidemiological data, current clinical practice guidelines, position papers, policy and legislation, and health theory, including internal practice-generated data, to present a health or system phenomenon. It leads directly to the clinical or system-generated PICOT question that drives the rest of the course and may become a publishable review. Choose a problem from your own setting. Because later papers build on this one, choose a problem you can study for the length of your DNP program.
Inside the DNP 704 Module 1 example
The paper moves from scope to guidelines to a system solution, then to local data, theory and significance, and ends with the PICOT question, the order the syllabus implies. National claims data establish the size of the gap, and the USPSTF statement clarifies where screening ends and post-fracture care begins. Internal chart review data show the problem exists locally. A planned-action framework explains why the gap persists. The PICOT question follows directly from the evidence and names a population, intervention, comparison, outcome and time. Each section ends by pointing to the next, so the argument builds steadily toward the question rather than presenting disconnected facts. Five sources support it. The question names all five elements.
Where the marks sit in the DNP 704 Module 1 rubric
Background and significance papers are usually graded on the depth and currency of the literature, inclusion of each required source type, use of internal data, clear presentation of the phenomenon's significance, a theory that fits, and a well-formed PICOT question, along with scholarly APA writing. Faculty look for a problem framed so the PICOT question feels inevitable. Local data are especially valued because they justify a DNP project in a specific setting. Synthesis across sources, rather than summaries of each, shows doctoral-level writing. Papers that explain why a gap persists, not only that it exists, set up the implementation work in later papers. Clear APA formatting is expected.
DNP 704 Module 1 help from the desk
Papers lose points when statistics pile up without an argument that leads to the question. Organize so each section leads to the next. Another is omitting internal data; even a small chart review strengthens the case. Include guidelines, policy and theory as the syllabus requires. Write the PICOT question last, once the evidence has shaped it. If you would like help developing your background and significance paper, send your topic and setting to the desk. Ask your manager early about access to internal data, since chart reviews or quality reports may need approval. Keep your PICOT outcome measurable. Draft early to leave time for revision.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 704 Module 1 questions, answered
Where can I find a free DNP 704 Module 1 sample paper?
Paper 1 is above in full: the osteoporosis treatment gap after fragility fracture, with national data, guidance, fracture liaison service evidence, internal chart review, theory and a PICOT question.
What is DNP 704 Paper 1?
A background and significance literature review that presents a clinical problem with research, data, guidelines, policy, theory and internal data, leading to a PICOT question.
How are the DNP 704 papers structured?
The syllabus describes four scaffolded papers, each building on the last, from background and significance to a final evidence-based practice paper.
Why include internal data in DNP 704?
The syllabus asks for internal practice-generated data, which shows the problem exists in your setting and justifies the project.
What is a fracture liaison service?
A coordinated program, often nurse-led, that identifies patients with fragility fractures and ensures bone health evaluation, treatment and follow-up.