3 Steps Cut Osteoporosis Hip Fractures
Study Shows Aggressive Approach to Osteoporosis Curbs Hip Fractures
By Miranda Hitti
Reviewed by Louise Chang, MD
Nov. 5, 2008 -- Getting aggressive about osteoporosis screening and treatment can go a long way toward preventing hip fractures, a new study shows.The researchers -- who work at Kaiser Southern California, a branch of the Kaiser Permanente health maintenance organization (HMO) -- say their strategy could cut U.S. hip fractures by 25% or more.Here's a look at their three-pronged approach to osteoporosis.
Step one: Bone scans. The researchers gave bone scans using dual X-ray absorptiometry (the gold standard for bone density tests) to the following patients:
All patients over age 50 with a history of fragility fractures (fractures not due to trauma)
All women over age 65
All men over age 70
All patients on high doses of corticosteroids and certain other drugs
Step two: Osteoporosis education and treatment. Patients with poor bone density or previous fragility fractures were included in the osteoporosis education program. And patients who needed osteoporosis treatment didn't just get bone drugs; they also got home safety checks to help prevent falls.
Step three: Fall prevention. The researchers created a fall-reduction program, including physical therapy, for at-risk patients.More than 620,000 patients were included in those programs at 11 Kaiser Southern California centers from 2002 to 2006.During that time, hip fractures dropped by 37% overall, ranging from 23% to nearly 61% across the 11 centers. The difference among the centers may be due to the fact that some centers had a longer history of the treating osteoporosis aggressively, note the Kaiser researchers, who included Richard Dell, MD.
Achieving that result didn't require experimental drugs or a radical change in screening. But it did require a coordinated, aggressive approach, Dell and the colleagues report."The first step must be a more active role by orthopaedic surgeons in osteoporosis disease management,"
Dell's team writes in November's edition of The Journal of Bone & Joint Surgery.