Knowledge and opinions of orthopaedic surgeons concerning medical evaluation and treatment of patients with osteoporotic fracture.
BACKGROUND
With the exponential increase in osteoporotic fractures, orthopaedic surgeons are in a logical position to become more involved in the medical treatment of this disease. However, it has been hypothesized that surgeons may not be inclined to initiate such treatment if they do not view medical interventions as an extension of their surgical opportunities. The objective of this study was to determine the knowledge and opinions of orthopaedic surgeons with regard to their opportunities for initiating medical treatment of patients with an osteoporotic fracture.


METHODS
A survey consisting of twenty-two questions was administered to 171 orthopaedic surgeons in Utah, Idaho, and Wyoming.


RESULTS
Of the 171 surveys that were mailed, 107 usable surveys were returned (a 63% response rate). A majority of the orthopaedic surgeons thought that it was appropriate to expand their orthopaedic practice to include prescribing pharmacological treatments for osteoporosis (68% agreed or strongly agreed with that statement). However, 47% were concerned enough about adverse events related to some conventional pharmacological treatments that they would rather avoid prescribing them. Of the surgeons who were willing to prescribe these treatments, 74% felt most comfortable prescribing bisphosphonates and >77% felt most comfortable prescribing calcium and vitamin-D supplements. Fifty-one percent considered an apparent osteoporotic fracture and several other clinical risk factors for osteoporosis as sufficient evidence for initiating pharmacological treatments, whereas 72% thought that a bone-density scan should be made before initiating treatment. Although 32% thought that all nonoperative treatment should be the responsibility of a primary care provider, 63% thought that the orthopaedic surgeon should initiate a workup to look for secondary causes of the osteoporosis and should begin medical treatment of patients with an osteoporotic fracture before referring them.


CONCLUSIONS
Although a majority of orthopaedic surgeons believe that they should expand their role in the medical treatment of patients with an osteoporotic fracture, many do not institute medical treatment and think that the patient's primary care providers should be responsible for medical care.
Skedros
John G
JG
Utah Bone and Joint Center, 5323 South Woodrow Street, Suite 202, Salt Lake City, UT 84107, USA. jskedros@utahboneandjoint.com
Holyoak
Joshua D
JD
Pitts
Todd C
TC
D015502:Absorptiometry, Photon; D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D019587:Dietary Supplements; D011307:Drug Prescriptions; D005598:Fractures, Spontaneous / Q000188:drug therapy*; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D009985:Orthopedics; D010024:Osteoporosis / Q000188:drug therapy*; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012307:Risk Factors; D014807:Vitamin D / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium