Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 7/2011

01-07-2011 | Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Optimizing Screening for Osteoporosis in Patients With Fragility Hip Fracture

Authors: Archana Roy, MD, Michael G. Heckman, MSc, Mary I. O’Connor, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2011

Login to get access

Abstract

Background

Osteoporosis, the underlying cause of most hip fractures, is underdiagnosed and undertreated. The 2008 Joint Commission report Improving and Measuring Osteoporosis Management showed only an average of 20% of patients with low-impact fracture are ever tested or treated for osteoporosis. We developed an integrated model utilizing hospitalists and orthopaedic surgeons to improve care of osteoporosis in patients with hip fracture.

Questions/purposes

Does our integrated model combining hospitalists and orthopaedic surgeons improve the frequency of evaluation for osteoporosis, screening for secondary causes, and patients’ education on osteoporosis?

Patients and Methods

Our Hospitalist-Orthopaedic Surgeon Integrated Model of Care was implemented in September 2009. We compared the rate of evaluation and treatment of osteoporosis in 140 patients admitted with fragility hip fracture at our institution before (70 patients) and after (70 patients) implementation of the care plan.

Results

Evaluation of patients for osteoporosis was higher in the postimplementation group compared to the preimplementation group (89% versus 24%). Screening of patients for secondary causes of osteoporosis was also improved in the postimplementation group (89% versus 0%), as was the proportion of patients who received education for osteoporosis management (89% versus 0%).

Conclusion

Our model of integrated care by hospitalists and orthopaedic surgeons resulted in improvement in the evaluation for osteoporosis, screening for secondary causes of osteoporosis, and education on osteoporosis management in patients with hip fracture at our institution. This may have important implications for treatment of these patients.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009;339:b3692.PubMedCrossRef
2.
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporos Int. 2000;11:556–561.PubMedCrossRef
3.
George A, Tracy JK, Meyer WA, Flores RH, Wilson PD, Hochberg MC. Racial differences in bone mineral density in older men. J Bone Miner Res. 2003;18:2238–2244.PubMedCrossRef
4.
Heaney RP. Bone mass, bone loss, and osteoporosis prophylaxis. Ann Intern Med. 1998;128:313–314.PubMed
5.
Janes H, Pepe MS, Gu W. Assessing the value of risk predictions by using risk stratification tables. Ann Intern Med. 2008;149:751–760.PubMed
6.
Kennel KA, Drake MT. Adverse effects of bisphosphonates: implications for osteoporosis management. Mayo Clin Proc. 2009;84:632–637; quiz 638.PubMedCrossRef
7.
Kok C, Sambrook PN. Secondary osteoporosis in patients with an osteoporotic fracture. Best Pract Res Clin Rheumatol. 2009;23:769–779.PubMedCrossRef
8.
Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J. Hip fracture incidence among elderly Asian-American populations. Am J Epidemiol. 1997;146:502–509.PubMed
9.
Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997;12:1761–1768.PubMedCrossRef
10.
National Osteoporosis Foundation. America’s Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation. Washington, DC: National Osteoporosis Foundation; 2002.
11.
National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.
12.
Nelson DA, Jacobsen G, Barondess DA, Parfitt AM. Ethnic differences in regional bone density, hip axis length, and lifestyle variables among healthy black and white men. J Bone Miner Res. 1995;10:782–787.PubMedCrossRef
13.
Nelson HD, Haney EM, Dana T, Bougatsos C, Chou R. Screening for osteoporosis: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:99–111.PubMed
14.
Schneider EL, Guralnik JM. The aging of America: impact on health care costs. JAMA. 1990;263:2335–2340.PubMedCrossRef
15.
The Joint Commission. Improving and Measuring Osteoporosis Management. Oakbrook Terrace, IL: The Joint Commission; 2007.
16.
US Department of Health and Human Services, Office of the Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General; 2004.
Metadata
Title
Optimizing Screening for Osteoporosis in Patients With Fragility Hip Fracture
Authors
Archana Roy, MD
Michael G. Heckman, MSc
Mary I. O’Connor, MD
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 7/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-011-1839-5

Other articles of this Issue 7/2011

Clinical Orthopaedics and Related Research® 7/2011 Go to the issue

Clinical Research

Bizarre Parosteal Osteochondromatous Proliferation: A Locally Aggressive Benign Tumor

Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Does a Multidisciplinary Team Decrease Complications in Male Patients With Hip Fractures?

Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium: Editorial Comment: A Call to Arms: Eliminating Musculoskeletal Healthcare Disparities

Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Gender and Race/Ethnicity Differences in Hip Fracture Incidence, Morbidity, Mortality, and Function

Clinical Research

Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Symposium:AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Keynote Address: The Need for Greater Racial and Ethnic Diversity in Orthopaedic Surgery