Pins and plaster aren't enough: a call for the evaluation and treatment of patients with osteoporotic fractures.
A history of an osteoporotic fracture is a powerful predictor of future fractures. Older patients who sustain low trauma fractures are candidates for interventions that should include confirmation of the diagnosis of osteoporosis, adequate calcium and vitamin D administration, and use of an osteoporosis therapy that is proven to lower fracture risk. Recently, however, several reports in the literature have indicated that, in general, those physicians who diagnose and treat fractures, i.e. radiologists, orthopedic surgeons, physiatrists, and those who provide general medical care to these fracture patients, the primary care physicians, are not evaluating patients with acute fractures for the presence of osteoporosis and are not prescribing calcium, vitamin D, or specific pharmacological therapy to reduce future fracture risk. These reports suggest that implementation of a standard of care for the subsequent medical management of the older patient with an acute fracture is needed urgently. Diagnostic tools and several effective therapies exist, but these are underused by the physicians who interface with these patients. A call to action is necessary to reduce the human and economic costs associated with this serious and treatable disease.
Siris
Ethel S
ES
Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA. es27@columbia.edu
Bilezikian
John P
JP
Rubin
Mishaela R
MR
Black
Dennis M
DM
Bockman
Richard S
RS
Bone
Henry G
HG
Hochberg
Marc C
MC
McClung
Michael R
MR
Schnitzer
Thomas J
TJ
D000368:Aged; D015519:Bone Density; D002986:Clinical Trials as Topic; D050723:Fractures, Bone / Q000601:surgery / Q000628:therapy*; D017408:Guidelines as Topic; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D011237:Predictive Value of Tests