Osteoporosis causes over 1.5 million fractures each year in this country. Indeed, by 2020, half of all Americans over 50 will have -- or be at risk for -- the disease. "It’s reaching epidemic proportions," said Samir Mehta, MD, chief of Orthopaedic Trauma and Fracture Service.
The problem is two-fold, he continued. “Musculo-skeletal issues have not always been appropriately managed because they’re not high on the priority list in terms of overall health-care management,” he said. “Elderly patients rarely talk to their doctors about osteoporosis. Calcium and vitamin D intake might be poor lifelong.”
The second issue is that osteoporosis is a silent disease, with no real warning signs. People may not know they have it until they break a bone.
To help identify patients at risk for fractures – and put them on the right track for prevention and treatment -- Penn Orthopaedics has brought Own the Bone on board. This quality improvement program from the American Orthopaedic Association tracks patients with fragility fractures and ensures that they receive appropriate follow up.
Karen Garden, CRNP, of the Orthopaedic Trauma and Fracture Service, explained that fragility fractures result from low energy injuries, for instance when people lose their balance while standing. “It usually starts with a fracture of the wrist or hip, but if you’ve had one fragility fracture, you’re in danger of having another,” she said.
Patients who come in with these fractures undergo blood tests to determine if the break occurred from a secondary cause, such as low calcium or thyroid disease, which can weaken bones. Secondly, the patient will be referred for a DEXA scan which measures bone mineral density. “Depending on the results, we direct patients to a primary care physician or to a specialist, such as an endocrinologist, rheumatologist, or geriatrician, for follow up.” Through a special field in EPIC, information identifying the patient as a fragility fracture patient can be accessed by health-care providers throughout the Health System. Additionally, through the Own the Bone program, correspondence is created and sent to the patient’s primary care physician, identifying them as having had a fragility fracture and inviting a conversation in follow-up about bone health and osteoporosis.
Mehta noted that Own the Bone is similar to Get with the Guidelines, a program which helps prevent future hospitalizations for heart failure patients. “We want to identify people at risk for fractures and put them on the right path so they don’t have a second fragility fracture.