Addressing Secondary Prevention of Osteoporosis in Fracture Care: Follow-up to “Own the Bone”

Abstract

The majority of the 1.8 million individuals who sustain a fracture annually in the United States have osteopenia or osteoporosis, yet <15% of these patients subsequently receive treatment for osteoporosis. A prospective cohort study was conducted to assess the effect of two different interventions on the rate of osteoporosis treatment in patients with a fragility fracture. Patients who were fifty years of age or older and were hospitalized for the treatment of a fragility fracture at either of two academic institutions were eligible for inclusion in the study. The intervention at one hospital involved immediate care for osteoporosis, including initiation of pharmacologic therapy during hospitalization. The intervention at the other hospital involved delayed care, including recommendations for osteoporosis counseling, bone-mineral density testing, and potential treatment for osteoporosis that were communicated to the primary care physician after the patient was discharged from the hospital. Patients were surveyed by telephone six months after the fracture, and their medical and pharmacy records were reviewed to verify the osteoporosis treatment that they had received. The mean age was 73 ± 10 years in the immediate-care group and 74 ± 12 years in the delayed-care group. Eighty percent of the patients were women. Sixty-five percent of the patients in each group completed the telephone interview six months after the fracture, and most had seen their primary care physician and undergone bone-mineral density testing. The rate of bone-mineral density testing was 92% in the immediate-care group compared with 76% in the delayed-care group. Both immediate and delayed care for osteoporosis resulted in a significant increase in the treatment rate compared with the baseline rate of 0% (p < 0.001). However, the primary care physician had initiated osteoporosis therapy by six months after the fracture in only 30% of the patients in the delayed-care group compared with a treatment rate of 67% in the immediate-care group (p < 0.001). Limitations of the study include the possibility that the findings resulted from a difference between the two study centers rather than between the two strategies. In addition, because of the academic and integrated nature of the medical systems at which the study was conducted, the findings cannot necessarily be extrapolated to other types of institutions. In summary, a recommendation for osteoporosis treatment made by an orthopaedic surgeon to the patient's primary care physician resulted in an increase in the rate of bone-mineral density testing and in the rate of therapy compared with baseline. However, immediate initiation of osteoporosis care during hospitalization for the fragility fracture resulted in a higher rate of treatment--with two-thirds of the patients receiving therapy six months after the fracture--compared with delayed initiation.

Augmentationstechnik am proximalen Femur

“…Entscheidend ist neben der chirurgischen Versorgung von Fragilitätsfrakturen somit aber auch die Einleitung einer weiterführende Sekundärprophylaxe, da das Vorliegen dieser Frakturen der stärkste Risikofaktor für die Entstehung weiterer Frakturen ist [3,22]. Die Abklärung und ggf.…”

“…Nach wie vor erhalten nur etwa 11-16 % aller Frauen und nur 3,4 % aller Männer mit Osteoporose eine adäquate Therapie [17]. Nach einer Studie von Edwards et al [3] erhöht die Empfehlung einer Osteoporosetherapie durch den Unfallchirurgen an den nachbehandelnden Arzt bereits die Therapieraten. Wenn jedoch die Osteoporosetherapie gleich während der Behandlung im Krankenhaus initiiert wird, sind die Complianceraten signifikant höher.…”

Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients’ bone health

“…The PQRS currently assesses the appropriate treatment of osteoporotic individuals, among other measures, and passes that information on to CMS to use as a determination of health care reimbursement rates [61]. It has also been suggested that soon the Joint Commission will be using similar quality measures during its assessment of hospitals for accreditation [23].…”

“…The presence of fragility fractures should lead to the consideration of treatment or at least exploration of bone metabolism. The orthopaedic surgeon is routinely involved in cases of fragility fractures, and many studies have shown that early osteoporosis screening by the orthopaedic surgeon, as part of the treatment plan, leads to better disease management [3,[22][23][24][25]. Orthopaedic surgeons are typically only involved in the osteoporotic patient's care as a consequence of a fracture and with the single biggest risk factor for a future fracture being a previous fragility fracture, it therefore follows that the area of focus for the orthopaedist should be on the secondary prevention of future fractures [4,26,27].…”

“…2), the initiation of pharmacological treatment if appropriate (Fig. 3) and obtaining or recommending a bone mineral densitometric analysis using dual-energy X-ray absorptiometry (DXA) [14,23]. In addition to diagnostic tests, the FRAX tool can also be used to assess a patient's ten year risk of fracture based on lab values and DXA scores if available [32].…”