Proactive measures can reduce
hip fracture rates by an average of 37.2 percent -- and as much as 50
percent -- among those at risk, according to a study conducted by Kaiser
Permanente Southern California. The study was published online on November
3 by The Journal of Bone & Joint Surgery, a peer-reviewed journal.
The largest study of its kind, the five-year study tracked more than
625,000 male and female patients over the age of 50 in Southern California
who had specific risk factors for osteoporosis and/or hip fractures. The
implementation of a number of initiatives in the Kaiser Permanente Southern
California Healthy Bones Program reduced the hip fracture rates beyond the
goal rate of 25 percent.
"One-half of all women and one-third of all men will sustain a
fragility fracture in their lifetime. The mortality rate due to
osteoporosis-related fractures is greater than the rates for breast cancer
and cervical cancer combined," said study lead author Richard M. Dell, MD,
an orthopedic surgeon at the Kaiser Permanente Bellflower Medical Center.
"Yet it's a misconception that nothing can be done to prevent or treat
osteoporosis. It is possible to achieve at least a 25 percent reduction in
the hip fracture rate in the United States if a more active role is taken
by all orthopedic surgeons in osteoporosis disease management."
The National Osteoporosis Foundation reports that although osteoporosis
can affect people of all ages, the problem of osteoporosis has reached
epidemic proportions with the rapidly aging population. Of the 10 million
Americans who have osteoporosis, 80 percent are women. More than 300,000
hip fractures are reported annually in the United States. Twenty-four
percent end up in a nursing home, 50 percent never reach their functional
capacity, and 25 percent of patients with a hip fracture die in the first
year after the incident.
Participating physicians in the study implemented a number of
initiatives including increasing the use of bone density test (DXA scans)
and anti-osteoporosis medications; adding osteoporosis education and home
health programs; and standardizing the practice guidelines for osteoporosis
management. The full article is found at
ejbjs/cgi/content/abstract/90/Supplement_4/188.
"Significant improvements in hip fracture rates are achievable wherever
orthopedic surgeons and treatment teams are willing to take a more active
role in osteoporosis disease management," Dell said.
Study authors include: Richard M. Dell, MD and Denise Greene, RNP, MS,
Department of Orthopedics, Kaiser Permanente Bellflower; Steven R.
Schelkun, MD, Department of Orthopedics, Kaiser Permanente San Diego; and
Kathyrn W. Williams, MSG, Department of Orthopedics, Kaiser Permanente
Fontana.
Recommendations for Prevention and Treatment of Osteoporosis
(Based on the ten steps outlined by Laura Tosi, MD, and the American
Orthopaedic Association's Own the Bone initiative.)
1. Be a champion. Remember that addressing the problem of fragility
fractures is multifaceted and will require a multidisciplinary
solution. Identify potential partners in your community.
2. Be proactive. Identify high-risk patients and don't wait until your
patient has a fragility fracture.
3. Teach your patients about osteoporosis and falls.
4. Develop pre-printed admission sheets and orders.
5. Develop a discharge checklist for fragility fracture patients, and
improve your discharge documentation.
6. Set realistic goals and measure what you've done.
7. Use the new fracture risk assessment tool called FRAX.
About the Kaiser Permanente Department for Research and Evaluation
The Department of Research and Evaluation conducts high-quality,
innovative research into disease etiology, prevention, treatment and care
delivery. Investigators conduct epidemiology, health sciences, and
behavioral research as well as clinical trials. Areas of interest include
diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and
cognition, pregnancy outcomes, women's and children's health, quality and
safety, and pharmacoepidemiology. Located in Pasadena, Calif., the
department focuses on translating research to practice quickly to benefit
the health and lives of Kaiser Permanente Southern California members and
the general population. Visit kp/research.
About Kaiser Permanente Research
Kaiser Permanente's eight research centers comprise one of the largest
research programs in the United States and engage in work designed to
improve the health of individuals everywhere. KP HealthConnect(TM), Kaiser
Permanente's electronic health record, and other resources provide
population data for research, and in turn, research findings are fed into
KP HealthConnect to arm physicians with research and clinical data. Kaiser
Permanente's research program works with national and local health agencies
and community organizations to share and widely disseminate its research
data. Kaiser Permanente's research program is funded in part by Kaiser
Permanente's Community Benefit division, which in 2007 directed an
estimated $1 billion in health services, technology, and funding toward
total community health.
About Kaiser Permanente
Kaiser Permanente is America's leading integrated health plan. Founded
in 1945, the program is headquartered in Oakland, Calif. Kaiser Permanente
serves 8.7 million members in nine states and the District of Columbia.
Today it encompasses Kaiser Foundation Health Plan, Inc., Kaiser Foundation
Hospitals and their subsidiaries, and the Permanente Medical Groups.
Nationwide, Kaiser Permanente includes approximately 164,000 technical,
administrative and clerical employees and caregivers, and 14,000 physicians
representing all specialties. The organization's Labor Management
Partnership is the largest such health care partnership in the United
States. It governs how more than 130,000 workers, managers, physicians and
dentists work together to make Kaiser Permanente the best place to receive
care, and the best place to work. For more Kaiser Permanente news, visit
the Kaiser Permanente News Center at: xnet.kp/newscenter.
Kaiser Permanente
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