The Orthopedic Surgeon’s Role in the Care of Fragility Fractures

Osteoporosis currently affects over twelve million Americans with another forty million affected by osteopenia or low bone mass [1]. Low bone mineral density has long been known to increase the risk of fragility fracture defined as “any fracture caused by injury that would be insufficient to fracture a normal bone”, typically occurring in the hip, vertebrae, wrist, and proximal humerus [2]. The annual incidence of fragility fractures is estimated at two million, with projections of an almost 50% increase in fractures and associated costs by 2025 [3]. At an incidence of two million new fractures per year this problem supersedes the combined incidence of heart attacks, stroke, and breast cancer [4]. After myocardial infarction, studies show beta blockers are initiated in approximately 85% of patients [5]. In contrast, antiosteoporosis treatments following fragility fracture are only initiated in 19% and 10% of privately insured women and men, respectively [6]. Bawa et al. showed that initiating anti-osteoporotic treatment after fragility fracture leads decreased risk of subsequent fracture by 40% within three years [7]. Within the United States, the cost of subsequent fractures is significant to commercial insurances and Medicare with estimates as high as $834 million and $1.13 billion, respectively [8]. The substantial osteoporosis-related health and economic impact on society has led to a heightened call for intervention at all levels of care. As the providers who care for these patients at the time of fracture, the onus is on orthopedic surgeons to help coordinate effective diagnostic and treatment strategies.