Treating osteoporosis after hip fracture

Most patients who suffer a hip fracture are referred to their primary care physicians for osteoporosis follow-up care.

However, according to a study published in the November 2008 issue of The Journal of Bone and Joint Surgery, an osteoporosis management program initiated by an orthopaedic surgeon can result in much better care for hip fracture patients.

Osteoporosis is a disease of progressive bone loss affecting 28 million Americans. The disease often develops unnoticed for many years, with no symptoms or discomfort until a fracture occurs because of the decreased bone density.

Osteoporosis is associated with fractures, and contributes to an estimated 1.5 million bone fractures each year. One in two women and one in five men older than 65, will sustain fractures caused by osteoporosis. Many of these are painful fractures of the hip, spine, wrist, arm, and leg, which often occur as a result of a fall.

The most serious and debilitating osteoporotic fractures are of the hip. Most patients who experience a hip fracture and previously lived independently will require some type of home care after the injury. All patients who experience a hip fracture will require walking aids for several months, and nearly half will permanently need canes or walkers.

Although osteoporosis is strongly associated with hip fractures, osteoporosis treatment following hip fractures occurs just 5 to 30 percent of the time.

"This low rate is the result of a few different factors," says Roberto Augusto Miki, M.D., assistant professor of clinical orthopaedics at University of Miami Jackson Memorial Hospital. "Most of these patients are older, and therefore may have a number of other health concerns. Their primary care physician is looking at the heart, lungs, and other more critical issues. Also, a lot of primary care physicians aren't that comfortable prescribing the specialized osteoporosis medications."

"In addition, orthopaedic surgeons frequently aren't prepared to take responsibility for osteoporosis management," Miki adds. "It's not a surgical issue - it's chronic disease management, and their practices aren't set up for that type of care."

In the study, researchers randomly selected 31 hip fracture patients to receive follow-up care at a specialized orthopaedic osteoporosis clinic and 31 to receive the usual type of treatment from their primary care physician. Six months following the initial hip fracture:

• 58 percent of patients in the orthopaedic clinic were still taking an osteoporosis medication.
• 29 percent of the patients in the primary care group were taking an osteoporosis medication.

In addition:

• 26 patients in the orthopedic group had undergone a bone mineral density test compared with 7 patients in the primary care group

Researchers initially planned to continue the study until they had enrolled 120 patients, but the early findings were so conclusive that the study was discontinued.

"Hospitals need systems and processes in place so that orthopaedic surgeons can refer osteoporosis patients to a specialist who can oversee disease management," Miki said.