Healthy bones program reduces hip fractures by 37%
10 November 2008
Proactive measures can reduce hip fracture rates by an average of
37.2% — and as much as 50% — among those at risk, according to a study
conducted by Kaiser Permanente Southern California. The study is
published online in the The Journal of Bone & Joint Surgery .
The five-year study, the largest of its kind, tracked more than
625,000 male and female patients over the age of 50 in Southern
California who had specific risk factors for osteoporosis and/or hip
fractures. The implementation of a number of initiatives in the Kaiser
Permanente Southern California Healthy Bones Program reduced the hip
fracture rates beyond the goal rate of 25%.
"One-half of all women and one-third of all men will sustain a
fragility fracture in their lifetime. The mortality rate due to
osteoporosis-related fractures is greater than the rates for breast
cancer and cervical cancer combined," said study lead author Richard M.
Dell, MD, an orthopedic surgeon at the Kaiser Permanente Bellflower
"Yet it's a misconception that nothing can be done to prevent or
treat osteoporosis. It is possible to achieve at least a 25% reduction
in the hip fracture rate in the United States if a more active role is
taken by all orthopaedic surgeons in osteoporosis disease management."
The National Osteoporosis Foundation reports that although
osteoporosis can affect people of all ages, the problem of osteoporosis
has reached epidemic proportions with the rapidly aging population. Of
the 10 million Americans who have osteoporosis, 80% are women. More than
300,000 hip fractures are reported annually in the United States.
Twenty-four percent end up in a nursing home, 50% never reach their
functional capacity, and 25% of patients with a hip fracture die in the
first year after the incident.
Participating physicians in the study implemented a number of
- increasing the use of bone density test (DXA scans);
- anti-osteoporosis medications;
- adding osteoporosis education and home health programs; and
- standardizing the practice guidelines for osteoporosis
"Significant improvements in hip fracture rates are achievable
wherever orthopedic surgeons and treatment teams are willing to take a
more active role in osteoporosis disease management," Dell said.
Recommendations for prevention and treatment of osteoporosis
(Based on the ten steps outlined by Laura Tosi, MD, and the American
Orthopaedic Association's Own the Bone initiative.)
- Be a champion. Remember that addressing the problem of fragility
fractures is multifaceted and will require a multidisciplinary
solution. Identify potential partners in your community.
- Be proactive. Identify high-risk patients and don't wait until
your patient has a fragility fracture.
- Teach your patients about osteoporosis and falls.
- Develop pre-printed admission sheets and orders.
- Develop a discharge checklist for fragility fracture patients,
and improve your discharge documentation.
- Set realistic goals and measure what you've done.
- Use the new fracture-risk assessment tool called FRAX.
1. Richard Dell, Denise Greene, Steven R Schelkun, and Kathy
Williams. Osteoporosis Disease Management: The Role of the Orthopaedic
Surgeon. The Journal of Bone and Joint Surgery (American).
The article can be accessed (payment required for full article) at
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