ROSEMONT, Ill., Dec. 5 /PRNewswire/ -- Osteoporosis is a condition of decreased bone mass that results in bones becoming weaker and more likely to fracture. According to the National Institutes of Health, osteoporosis is a major public health threat for 44 million Americans, 68 percent of whom are women. This disabling condition is implicated in 1.5 million fractures each year in the United States alone, and it is a significant cause of musculoskeletal pain, deformity, disability, and even death.
In a study published in the December 2003 issue of The Journal of Bone and Joint Surgery, preventive medicine physician Adrianne C. Feldstein, MD, MS, reports that older women with fractures may not be managed in accordance with evidence-based clinical guidelines for osteoporosis.
“These guidelines suggest that older women with fragility fractures should either be treated for clinically apparent osteoporosis, or they should have bone mineral density measurements, followed by treatment when appropriate,” Dr. Feldstein stated. According to Dr. Feldstein, most fragility fractures, and particularly certain kinds of fractures -hip, spine and some wrist fractures - serve as markers that are associated with osteoporosis. Fragility, or low-energy fractures are those resulting from a fall from a standing height or less, or presenting in the absence of obvious trauma.
Dr. Feldstein is Assistant Medical Liaison for Research and an Adjunct Investigator at the Kaiser Permanente Center for Health Research; Portland, Or. Dr. Feldstein and her colleagues conducted this study, funded by the Agency for Healthcare Research and Quality, to gain further insight into the gaps between osteoporotic fractures and evaluation/treatment so they can design more effective future interventions to protect older women. Collaborating on this research were Gregory Nichols, PhD; Patricia Elmer, PhD, MS; David Smith, RPH, MHA, PhD; and Mikel Aickin, PhD, also of Kaiser Health Research; and Michael Herson, MD, of Northwest Permanente; Portland, Or.
The study population included 3,812 women from a health maintenance organization (HMO) who were age 50 and over with a diagnosis of a new fracture within the period of the study. Dr. Feldstein found a substantial gap between clinical guidelines and practice with regard to the measurement of bone mineral density and pharmaceutical treatment after fractures. She found that less than half of these women received a bone mineral density measurement or a medication for osteoporosis. This gap has not been previously described as comprehensively.
In general, women have a 50 percent lifetime risk of sustaining an osteoporotic fracture. At the age of 50, for example, a white woman has a 16 percent lifetime risk of sustaining a hip fracture, one of the most serious fractures. The risk of hip fracture is greater than the risk of breast cancer, at 11 percent. Dr. Feldstein urges post-menopausal women and older men who have had a fracture to ask their healthcare provider about their risk of osteoporosis. Younger fracture patients should discuss osteoporosis with their healthcare provider if they have additional risk factors, such as low weight, smoking, family history, and use of certain medications, such as steroids. “Every patient who has had a low-energy fracture should consider, ‘I broke a bone. Maybe I have weak bones. I need to discuss this possibility with my physician,’” Dr. Feldstein said.
The American Academy of Orthopaedic Surgeons (AAOS) urges both the medical community and patients to be aware of the risk factors for osteoporosis. Preventive medicine physicians such as Dr. Feldstein have provided the research to clarify gaps in identification and treatment of this debilitating disease.
Laura Tosi, MD, orthopaedic surgeon and former chair of the American Academy of Orthopaedic Surgeons’ Committee on Women’s Issues, supports the study results and adds, “One of the most compelling reasons to determine the etiology of a fracture and provide appropriate treatment is that a previous low-energy fracture is among the strongest risk factors for new fractures.”
The AAOS recently provided its membership with recommendations for enhancing the care of patients with fragility fractures. The recommendations include:
1. Consider the likelihood that osteoporosis is a predisposing factor when a patient presents with a fragility fracture. 2. Advise patients with fragility fractures that an osteoporosis evaluation may lead to treatment which can reduce the risk of future fractures. 3. Initiate an investigation of whether osteoporosis is an underlying cause in patients with fragility fractures. The orthopaedic surgeon may conduct this evaluation or may refer the patient to another medical provider. 4. Establish partnerships within the medical and nursing community that facilitate the evaluation and treatment of patients with fragility fractures. 5. Urge their hospitals and office practices to establish clinical pathways that ensure optimal care is provided for patients with fragility fractures.
Orthopaedic surgeons have a unique opportunity to educate the fracture patient about the need to decrease the risk for future fractures and to advocate for improved fracture care in their communities.
The U.S. Preventive Services Task Force, sponsored by AHRQ, recently recommended that all women 65 and older be routinely screened for osteoporosis to reduce the risk of fracture and spinal abnormalities often associated with the disease. The Task Force also recommended that routine screening begin at 60 for those women identified as high risk because of their weight or lack of estrogen use.
Other protective strategies include taking calcium and vitamin D daily, preferably in diet, but if necessary in supplements. Weight-bearing or resistive exercise, such as walking, dancing, jogging, or weight-lifting also is important. Exercise contributes to preventing natural bone loss and strengthens muscles, which helps us maintain our sense of balance and avoid falls, which further reduces the risk of fractures.
The Journal of Bone and Joint Surgery (JBJS) is a publication of the 26,000-member American Academy of Orthopaedic Surgeons (http://www.aaos.org/ or http://orthoinfo.aaos.org/ ), a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals, and the public.
The peer-reviewed JBJS, located in Needham, Massachusetts, is published monthly. Abstracts are available online at http://www.jbjs.org/ .
An orthopaedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, and nerves.
American Academy of Orthopaedic Surgeons
CONTACT: Claudette Yasell, +1-847-384-4035, yasell@aaos.org , or MindyWeinstein, +1-847-384-4034, weinstein@aaos.org , both of American Academy ofOrthopaedic Surgeons