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

Abstract

Osteoporosis has been recognised as a public health concern for at least three decades but it has been relatively recent that the push has been for orthopaedic surgeons to take a more active role in the diagnosis and treatment of patients with decreased bone mineral density (BMD). Most often these patients are encountered after they have suffered a fracture making secondary prevention the area where orthopaedists may exert the greatest influence on patient care. The purpose of this article is to provide a succinct framework for the diagnosis and treatment of patients with decreased BMD. Patients are deemed to have decreased BMD if they have suffered a fragility fracture, a fracture caused by a lowenergy traumatic event. These patients are often encountered in the emergency department and admitted for further treatment of their fractures or recommended for follow-up in the clinic. Regardless of treatment course these are opportunities for the orthopaedic surgeon to intervene in the osteoporotic disease process and positively affect a patient's bone health. This article compiles the available literature on osteoporosis and presents it succinctly with the incorporation of both a diagnosis algorithm and treatment profile table. With the use of these two tools, orthopaedic surgeons everywhere should be able to take a more active role in their patients' bone health.

The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures

“…Lack of recognition and knowledge of orthopedic surgeon for the osteoporotic fracture may be one of the reasons. 11 21 22 23 24 25) Sorbi and Aghamirsalim 25) reported that the typical orthopedic surgeon is not inclined to manage patients with osteoporotic fracture appropriately due to lack of knowledge in comparison with internist, which raised questions concerning their role in the management of osteoporosis. Several reports suggested that awareness of orthopedic surgeon reduces the risk of osteoporotic fracture and education is the way to improve management for osteoporosis.…”

Elcatonin attenuates disuse osteoporosis after fracture fixation of tubular bone in rats

“…Moreover, data showed that ECT did not delay the overall fracture healing process compared to alendronate which strongly suppressed callus remodeling in cynomolgus monkeys [ 9 ]. ECT and salmon calcitonin have been worldwide used for the prophylaxis and treatment of osteoporosis [ 14 , 16 , 17 ], but a beneficial effect of ECT on bone has not been evaluated in surgically induced DOP yet.…”

Hip fractures in 2016, where do we stand and have we made any progress?

“…Despite such anticipated changes, meaningful progress on the various multifaceted topics related to hip fractures has been scarce and the 1 -ear mortality has not changed significantly. Preventative measures such as early diagnosis/treatment of osteoporosis and fall prevention have now been implemented in most developed countries [2]. Strategies such as fast tracking of patients with hip fractures or enhanced recovery programs are now well in place [3,4].…”