title: The orthopaedic surgeon's role in diagnosing and treating patients with osteoporotic fractures: standing discharge orders may be the solution for timely medical care.
abstract: Patients who suffer osteoporotic fractures do not typically receive medical/pharmaceutical treatment for osteoporosis. Orthopedic surgeons are concerned about, but not always diligent in following up on, the medical treatment of their fracture patients. The objective of this study was to determine whether orthopedic surgeons could effectively and consistently refer patients with osteoporotic fractures to a primary care provider (PCP) for possible work-up and treatment of osteoporosis. Fourteen orthopedic surgeons participated in the program. Sixty-nine qualifying patients were >/=50 years old, had a low-energy fracture, and had no prior treatment for osteoporosis. For each patient, two letters requesting a PCP appointment were sent to their PCP: one within 10 days of fracture and another 3-10 weeks after fracture. Patients were also instructed that they might have osteoporosis, and were directed to see their PCP. Results showed that of 69 patients (59 females, ten males: average age 69.5+/-10.9 years), 30 (43.5%) did not see a PCP within 84 days. Thirty-nine (56.5%) patients saw a PCP within 84 days, but osteoporosis was not addressed in four (average days to PCP, 39.8+/-18.6: range 7-78 days). Of patients seen within 84 days, anti-resorptive medications (e.g. bisphosphonate) were started in 21/39 (53.8%), but typically not within 41 days of fracture. Of the 14 orthopedic surgeons, five were non-compliant and seven were inconsistent in their participation, forgetting to send the letters and/or inform patients to make PCP appointments. Standing discharge orders (for medications, PCP follow-up, bone-density scanning, etc.) may be more effective in achieving timely medical treatment for patients of orthopedic surgeons with osteoporotic fractures.
authors.affiliation: Utah Bone & Joint Center, 5323 South Woodrow Street, Suite 202, Salt Lake City, UT 84107, USA. jskedros@utahboneandjoint.com
authors.forename: John G
authors.initials: JG
authors.lastname: Skedros
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000458:organization & administration; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D010351:Patient Discharge / Q000592:standards; D010819:Physician's Role; D011320:Primary Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D014589:Utah