Nov. 7, 2008 Proactive measures can reduce hip fracture rates by an average of 37.2 percent -- and as much as 50 percent -- among those at risk, according to a study conducted by Kaiser Permanente Southern California.
The study was published online on November 3 by The Journal of Bone & Joint Surgery, a peer-reviewed journal.
The largest study of its kind, the five-year study tracked more than 625,000 male and female patients over the age of 50 in Southern California who had specific risk factors for osteoporosis and/or hip fractures. The implementation of a number of initiatives in the Kaiser Permanente Southern California Healthy Bones Program reduced the hip fracture rates beyond the goal rate of 25 percent.
"One-half of all women and one-third of all men will sustain a fragility fracture in their lifetime. The mortality rate due to osteoporosis-related fractures is greater than the rates for breast cancer and cervical cancer combined," said study lead author Richard M. Dell, MD, an orthopedic surgeon at the Kaiser Permanente Bellflower Medical Center. "Yet it's a misconception that nothing can be done to prevent or treat osteoporosis. It is possible to achieve at least a 25 percent reduction in the hip fracture rate in the United States if a more active role is taken by all orthopedic surgeons in osteoporosis disease management."
The National Osteoporosis Foundation reports that although osteoporosis can affect people of all ages, the problem of osteoporosis has reached epidemic proportions with the rapidly aging population. Of the 10 million Americans who have osteoporosis, 80 percent are women. More than 300,000 hip fractures are reported annually in the United States. Twenty-four percent end up in a nursing home, 50 percent never reach their functional capacity, and 25 percent of patients with a hip fracture die in the first year after the incident.
Participating physicians in the study implemented a number of initiatives including increasing the use of bone density test (DXA scans) and anti-osteoporosis medications; adding osteoporosis education and home health programs; and standardizing the practice guidelines for osteoporosis management.
"Significant improvements in hip fracture rates are achievable wherever orthopedic surgeons and treatment teams are willing to take a more active role in osteoporosis disease management," Dell said.
Study authors include: Richard M. Dell, MD and Denise Greene, RNP, MS, Department of Orthopedics, Kaiser Permanente Bellflower; Steven R. Schelkun, MD, Department of Orthopedics, Kaiser Permanente San Diego; and Kathyrn W. Williams, MSG, Department of Orthopedics, Kaiser Permanente Fontana.
Recommendations for Prevention and Treatment of Osteoporosis (Based on the ten steps outlined by Laura Tosi, MD, and the American Orthopaedic Association's Own the Bone initiative.)
- Be a champion. Remember that addressing the problem of fragility fractures is multifaceted and will require a multidisciplinary solution. Identify potential partners in your community.
- Be proactive. Identify high-risk patients and don't wait until your patient has a fragility fracture.
- Teach your patients about osteoporosis and falls.
- Develop pre-printed admission sheets and orders.
- Develop a discharge checklist for fragility fracture patients, and improve your discharge documentation.
- Set realistic goals and measure what you've done.
- Use the new fracture risk assessment tool called FRAX.
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- Dell et al. Osteoporosis Disease Management: The Role of the Orthopaedic Surgeon. The Journal of Bone and Joint Surgery, 2008; 90 (supplement 4): 188 DOI: 10.2106/JBJS.H.00628
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