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Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 1/2015

01-02-2015 | Orthopedic Management of Fractures (D Little and T Miclau, Section Editors)

Fragility Fracture Programs: Are They Effective and What Is the Surgeon’s Role?

Authors: Jay S. Bender, Eric G. Meinberg

Published in: Current Osteoporosis Reports | Issue 1/2015

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Abstract

Fragility fractures are occurring at an ever-increasing rate, creating an enormous economic and societal impact. Outpatient-based fragility fracture programs have been developed to identify at-risk patients, initiate effective treatment of metabolic bone disease, and improve coordination between members of the patient’s care team with the goal of reducing future fractures. Inpatient programs focus on effective, efficient management of patients presenting with acute fractures. Both have proven successful in reducing the impact of fragility fractures, but many challenges exist. The orthopedic surgeon, as part of an integrated team of providers, is integral in identifying at-risk patients, ensuring appropriate care of acute fractures, and initiating treatment protocols to reduce the risk of further injuries.
Literature
1.
Administration on Aging: a profile of older Americans. Administration on Aging. United States Department of Health and Human Services, 2011.
2.
National Center for Health Statistics: Health, United States, 2011: In Brief. Hyattsville, MD. 2012.
3.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.PubMedCrossRef
4.
Browner BD. The bone and joint decade, 2000–2010. J Bone Joint Surg Am. 1999;81(7):903–4.
5.
Tosi LL, Gliklich R, Kanna BA, Koval K. The American Orthopaedic Association’s “Own the Bone” initiative to prevent secondary fractures. J Bone Joint Surg Am. 2008;90:163–73.PubMedCrossRef
6.
7.
8.
9.
Vaile JH, Sullivan L, Conner D, Bleased JF. A year of fractures: a snapshot analysis of the logistics, problems and outcomes of a hospital based fracture liaison service. Osteoporos Int. 2013;24:2619–25.PubMedCrossRef
10.
Cosman F, de Beur SJ, Leboff MS, Lewiecki, Tanner B, Randall S, Lindsay R. Clinician’s guide to prevention and treatment of osteoporosis. Osteopoross Int 2014; volume 25 Issue 8 pending publication.
11.
Bolland MJ, Grey AB, Gamble GD, Reid IR. Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab. 2010;95(3):1174–81.PubMedCrossRef
12.
MacLean C et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone mineral density or osteoporosis. Ann Intern Med. 2008;148:197–213.PubMedCrossRef
13.
Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, et al. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int. 2011;22:2051–65.PubMedCrossRef
14.••
Li Y-T, Cai HF, Zhang ZL. Timing of the initiation of bisphosphonates after surgery for fracture healing: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2014; published online. This review summarized ten different articles with 2888 patients. The studies were culled from PubMed, the Cochrane Library and Embase. Different bisphosphonate treatment protocols all started within 3 months of fragility fracture surgery. There was no difference in healing rates between treated and non-treated patients.
15.
Uchiyama S, Itsubo T, Nakamura K, Fujinaga Y, Sato N, Imaeda T, et al. Effect of early administration of alendronate after surgery for distal radial fragility fracture on radiological fracture healing time. Bone Joint J. 2013;95-B:1544–50.PubMedCrossRef
16.
Xue D, Li F, Chen G, Yan S, Pan Z. Do bisphosphonates affect bone healing? A meta-analysis of randomized controlled trials. J Orthop Surg Res. 2014;9:45.PubMedCentralPubMedCrossRef
17.•
O’Malley NT, Blauth M, Suhm N, Kates SL. Hip fracture management, before and beyond surgery and medication: a synthesis of the evidence. Arch Orthop Trauma Surg. 2011;131:1519–27. This review article confirms the cost effectiveness of fracture care that is initiated in the hospital. Post-hospital programs are questioned as no benefit in future fall or fracture reductions were noted.PubMedCrossRef
18.
Edwards BJ, Koval K, Bunta AD, Genuario K, Hahr A, Andruszyn L, et al. Addressing secondary prevention of osteoporosis in fracture care: follow-up to “Own the Bone”. J Bone Joint Surg Am. 2011;93(15):e87.PubMedCrossRef
19.
Goltz L, Degenhardt G, Maywald U, Kirch W, Schindler C. Evaluation of a program of integrated care to reduce recurrent osteoporotic fractures. Pharmacoepidemiol Drug Saf. 2013;22(3):263–70.PubMedCrossRef
20.
McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int. 2011;22(7):2083–98.PubMedCrossRef
21.
Mikki RA, Oetgen ME, Kirk J, Insogna KL, Lindskok. Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. J Bone Joint Surg Am. 2008;90:2346–5.CrossRef
22.
Carpintero P, Gil-Garary E, Hernandez-Vaquero D, Ferrer H, Munuera L. Interventions to improve inpatient osteoporosis management following first osteoporotic fracture: the PREVENT project. Arch Orthop Trauma Surg. 2009;129:245–50.PubMedCrossRef
23.
Banakh I. PRO_OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single center study. Arch Osteoporos. 2011;6:157–65.PubMedCrossRef
24.
Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med. 2009;169(18):1712–7.PubMedCrossRef
25.
Kates SL, Blake D, Bingham KW, Kates OS, Mendelson DA, Friedman SM. Comparison of an organized geriatric fracture program to United States government data. Geriatr Orthop Surg Rehabil. 2010;1(1):15–21.PubMedCentralPubMedCrossRef
26.
Kates SL, Mendelson DA, Friedman SM. The value of an organized fracture program for the elderly: early results. J Orthop Trauma. 2011;25(4):233–7.PubMedCrossRef
27.
Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6–14.PubMedCentralPubMedCrossRef
28.
Menzies IB, Mendelson DA, Kates SL, Friedman SM. The impact of comorbidity on perioperative outcomes of hip fractures in a geriatric fracture model. Geriatr Orthop Surg Rehabil. 2012;3(3):129–34.PubMedCentralPubMedCrossRef
29.
Gleason LJ, Menzies IB, Mendelson DA, Kates SL, Friedman SM. Diagnosis and treatment of osteoporosis in high-risk patients prior to hip fracture. Geriatr Orthop Surg Rehabil. 2012;3(2):79–83.PubMedCentralPubMedCrossRef
30.•
Sharif KM, Dimitriou R, Giannoudis PV. What is the role of the orthopaedic surgeon in management of fragility fractures? J Orthop Trauma. 2011;Suppl 2:S47–50. This article reiterates the positive impact that active management by the treating orthopedic surgeon has on patient outcomes. Evaluation of fracture etiology, fall prevention and therapy, supplementation of Vitamin C and calcium, as well as initiation of bisphosphonates or anabolic agents are all outlined as within the scope of the orthopedic surgeon. The utilization of a dedicated multidisciplinary team in the treatment of the patient with a fragility fracture is also emphasized.CrossRef
31.
Ekman EF. The role of the orthopaedic surgeon in minimizing mortality and morbidity associated with fragility fractures. J Am Acad Orthop Surg. 2010;18(5):278–85.PubMed
32.
Collinge C, LeBus G, Gardner MJ, Gehrig L. Osteoporosis in orthopaedic trauma patients: a diagnosis and treatment protocol. J Orthop Trauma. 2008;22(8):541–7. discussion 548–9.PubMedCrossRef
33.
Farmer RP, Herbert B, Cuellar DO, Hao J, Stahel PF, Yasui R, et al. Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients’ bone health. Int Orthop. 2014;38(8):1731–8.PubMedCrossRef
34.
Solomon DH, Patrick AR, Schousboe J, Losina E. The potential economic benefits of improved postfracture care: a cost-effectiveness analysis of a fracture liaison service in the US health-care system. J Bone Miner Res. 2014;29(7):1667–74.PubMedCrossRef
Metadata
Title
Fragility Fracture Programs: Are They Effective and What Is the Surgeon’s Role?
Authors
Jay S. Bender
Eric G. Meinberg
Publication date
01-02-2015
Publisher
Springer US
Published in
Current Osteoporosis Reports / Issue 1/2015
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-014-0251-y

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