Editor’s Choice – May 5, 2014

The article “Declining Rates of Osteoporosis Management Following Fragility Fractures in the U.S., 2000 through 2009” by Balasubramanian, et al. in the April 2, 2014 JBJS is a bit discouraging, but it will hopefully serve as a wake-up call for orthopaedic surgeons to re-engage with our patients to diagnose and treat previously undetected osteoporosis.

Fragility fractures–which primarily affect the vertebrae, hip, distal radius, or proximal humerus–are often the initial indication of osteoporosis in older individuals. For more than a decade, orthopaedic surgeons treating these fractures have been strongly encouraged to evaluate patients in this age group for the osteoporosis generally associated with these fractures. The American Orthopaedic Association (AOA) in 2005 began developing the Own the Bone program, specifically addressing the need to evaluate and treat osteoporosis, as well as the fracture, in these patients. The AOA has formed liaisons with several other national organizations to advance this program, and by late 2013, 44 states had hospitals implementing Own the Bone at their local institutions.

This article is sobering. Despite concerted efforts to link care of fragility fractures to evaluation and treatment of co-existing osteoporosis, these authors report an actual decrease in the rate of osteoporosis management for these patients. Only one-third of the women and one-sixth of the men in this retrospective cohort study were evaluated and treated according to current clinical guidelines.

This is an important public health issue. Despite the fact osteoporosis management involves non-operative treatment, it is essential that orthopaedic surgeons become more cognizant of the association between fragility fractures and osteoporosis treatment, and put in place a protocol to ensure that these patients are evaluated and treated for osteoporosis, as well as for the fracture. Osteoporosis may not be under the direct guidance of the orthopaedic surgeon, but the recognition of this potential problem is squarely within the practice scope of orthopaedists, who are well positioned to initiate secondary prevention measures for these older individuals.