Most Seniors Who Break Bones in Falls Not Tested,
Treated for Cause
Half of all women and one-quarter of all men will
suffer at least one fragility fracture after age 50
March 24, 2014 – Older people who break a bone in a
fall from no greater than their standing height - called a “fragility
fracture” - are two to five times more likely to suffer another than
someone who has not suffered such a break. And it appears to be
progressive – if they suffer a second facture the odds of a third are
even higher. Surprisingly, most of these seniors are not tested or
treated for what causes most of these fractures.
The underlying cause for the vast majority of these
non-traumatic fractures is osteoporosis, a progressive disease that
decreases the weight and density of bones, making them more brittle.
Osteoporosis doesn’t have any obvious symptoms so in most cases it isn’t
noticed until a fracture occurs – and those fractures are anything but
According to the National Osteoporosis Foundation
(NOF), approximately half of all women and one-quarter of all men will
suffer at least one fragility fracture after age 50.
There are more than 2 million fragility fractures
in the United States each year – more than the number of heart attack,
stroke and breast cancer cases combined – with an estimated direct cost
of nearly $20 billion. These breaks can significantly damage an
individual’s quality of life and contribute to other serious health
problems, even death.
Despite all that, roughly 80 percent of all older
Americans who sustain fractures are neither tested nor treated for
“Orthopaedics has traditionally focused on fixing
the fracture, but we’ve realized that is only part of our responsibility
as physicians,” said Cynthia Emory, M.D., an orthopaedic surgeon at Wake
Forest Baptist Medical Center.
“Identifying and treating the underlying cause is
equally important so we can prevent fractures from occurring and enable
our patients to continue doing the activities they enjoy.”
Experts agree that fracture liaison services
represent a very effective way to do both the identifying and the
A fracture liaison service (FLS) is a
multispecialty, preventive-care program designed to foster bone health
in older adults, thereby reducing the risk of fragility fractures.
Well-established and with proven records of success abroad, notably in
the United Kingdom and Canada, FLS programs are catching on in the
United States, thanks in part to initiatives by the NOF, National Bone
Health Alliance (NBHA), American Orthopaedic Association and other
Last fall Wake Forest Baptist became one of the
first academic medical centers in the country to establish a formal FLS
program. That effort was led by Emory; fellow orthopaedic surgeon Anna
Miller, M.D.; and certified nurse practitioner Anne Lake, who serves as
the program’s coordinator.
Wake Forest Baptist’s FLS enrolls people 50 and
over who have suffered a fracture or who have a medical condition that
can adversely affect bone density. The initial visit for each patient
includes a thorough review of his or her medical history and a physical
examination. Depending on what those reveal, lab tests, X-rays and a
bone-density scan may be administered.
After all the results are collected and analyzed,
the patient receives an individualized plan that may include an exercise
program, dietary and lifestyle recommendations, non-prescription
supplements and prescription medications, all geared toward increasing
bone health and decreasing the risk of future breaks.
Patients are scheduled for follow-up visits as
needed, during which their progress is evaluated and their care plan is
adjusted, if necessary.
The service provides “full-perspective care
coordination,” said Lake, whose job as FLS coordinator includes
gathering all the information about the patients, developing their
therapy plans, guiding the patients through the program and keeping all
of their doctors and other caregivers in the loop about their status.
“Orthopaedists and primary-care physicians
obviously play major roles,” said Lake, who holds a doctor of nursing
practice degree. “But we’ll also consult endocrinologists,
rheumatologists, dietitians, physical therapists – basically anyone who
can contribute to determining what’s best for the individual patient.”
In addition to managing Wake Forest Baptist’s
service, Lake is involved in efforts by the NOF and NBHA to provide
hospitals and other providers with models that will help them establish
FLS programs regardless of their size or scope and to develop standards
for FLS programs with an eye toward their being recognized by The Joint
Commission, the independent organization that accredits and certifies
health care organizations and programs in the United States.
“Fracture liaison services incorporate three
important aspects of health care that are being emphasized today –
prevention, coordinated care and personalized medicine,” Miller said.
“They have been proven to be very successful in reducing the number of
fragility fractures, so there’s every good reason to make them available
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