title: Osteoporotic Fracture Program management: who should be in charge? A comparative survey of knowledge in orthopaedic surgeons and internists.
abstract: BACKGROUND
  Osteoporosis has been described as a progressive skeletal disorder until a patient experiences a fragility fracture. The number of patients with osteoporotic fractures is increasing at an exponential rate. Orthopaedic surgeons, most of the time, first clinicians seen by patients at the time of fracture, do not routinely consider osteoporosis management. Therefore, we compared the knowledge of orthopaedic surgeons and internists regarding medical treatment required: which group would have more abilities to keep patients with osteoporotic fractures under management?
  
  
  OBJECTIVE
  We hypothesize that internists may have more abilities to assess and treat osteoporosis for patients with osteoporotic fractures; therefore, referring these patients to this specialized team for post-fracture medical consultation is required.
  
  
  METHODS
  A questionnaire composed of seven closed questions was administered to 4700 orthopaedic surgeons and internists. This question list addressed the orthopaedic surgeons' and internists' knowledge in managing patients with osteoporotic fractures. The questions were designed in a way to cover the topics of diagnosis, treatment, and approach to an osteoporotic patient with osteoporotic fractures.
  
  
  RESULTS
  In this survey, 3431 respondents were included. Only 118 (fewer than 10%) orthopaedic surgeons would order bone mineral densitometry (BMD) in osteoporotic fractures in contrast to 1544 (79%) internists. Approximately 1485 (76%) internists against 487 (33%) orthopaedic surgeons prescribe proper dosage of calcium and vitamin D.
  
  
  CONCLUSIONS
  Typical orthopaedic surgeon is not naturally inclined to manage patients with osteoporotic fractures. The existing management gap between the occurrence of an osteoporotic fracture and the identification and treatment of osteoporosis requires multifaceted intervention. Improved communication between orthopaedic surgeons and internists may reduce this gap between fracture occurrence and osteoporosis management.
  
  
  METHODS
  Level III prospective diagnostic study.
authors.affiliation: Students' Scientific Research Center (SSRC), Exceptional Talent Development Center (ETDC), Tehran University of Medical Sciences (TUMS), Shahrake Ekbatan, 1394813799 Tehran, Iran.
authors.forename: R
authors.initials: R
authors.lastname: Sorbi
authors.forename: M
authors.initials: M
authors.lastname: Aghamirsalim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002983:Clinical Competence; D003720:Densitometry; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000517:prevention & control; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000592:standards / Q000639:trends; D007492:Iran; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009985:Orthopedics / Q000592:standards / Q000639:trends; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: Fragility fracture; Internist; Orthopaedic surgeon; Osteoporosis; Osteoporotic fracture