Six Ways to Lower Hip-Fracture Rates

Adopting a set of aggressive guidelines to manage patients with osteoporosis, or “bone-thinning,” can lower hip-fracture rates by more than 37 percent, a recent study showed.     Fractures in hip bones made brittle by osteoporosis are a leading cause of earlier-than-normal death among seniors and are a major drain on the U.S. health-care system.

Kaiser Permanente did a study in its hospital system, the results of which were published in the Journal of Bone and Joint Surgery. The researchers found that increasing the use of DXA (dual energy X-ray absorptiometry) scans and anti-osteoporosis drugs led the way in reducing the hip-fracture rate by 37.2 percent.
   
“It’s a misconception that nothing can be done to prevent or treat osteoporosis,” said Richard Dell, a physician with Kaiser Permanente Bellflower. “It is possible to achieve a … 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.”
   
Dell and his colleagues studied more than 620,000 patients in the Kaiser Permanente hospital system – mostly womLen older than 65, men over 70 and people older than 50 who had a previous fracture – and found that six factors helped to sharply reduce the hip-fracture rate.
   
1) Increase the use of DXA scans. The researchers noted that the number of these scans rose by 247 percent, from 21,557 per year in 2002, the first year of the program, to 74,770 in 2006.
   
2) Boost the use of anti-osteoporosis medicines. The yearly number of patients managed with drugs for osteoporosis rose 135 percent, from 33,208 in 2002 to 78,058 in 2006.
   
3) Create a list of risk factors to look for. These include performing blood tests for calcium, phosphate, 25 hydroxyvitamin D and thyroid stimulating hormone.

4) Develop a checklist for patients to give them when they’re discharged from the hospital. The list includes a prescription for calcium (1,200 milligrams daily), a recommendation for vitamin D (800 IU daily), a referral to physical therapy for fall-prevention education, a home-safety check and patient-education materials.

5) Include the telling terms “fragility fracture” and “osteoporosis” in the hospital discharge summary.

6) Use the World Health Organization’s fracture-risk assessment tool, known as FRAX, in deciding how to treat a patient’s osteoporosis, instead of relying solely on a DXA scan.


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