New Osteoporosis Care Data

A team of researchers from Virginia has moved the needle on understanding the problem of osteoporosis care.

Their study, “Orthopedic surgeons’ views on the osteoporosis care gap and potential solutions: survey results,” appears in the March 6, 2019 edition of the Journal of Orthopaedic Surgery and Research.

Co-author David W. Barton, an M.D. Candidate, Class of 2019 at the Virginia Tech Carilion School of Medicine in Roanoke, Virginia, told OTW, “We were seeing a lot of patients who were presenting with their second, third, or even fourth fracture without having been screened or treated for osteoporosis.”

According to the study authors, “Thirty-six of 47 survey recipients (77%) responded to the first survey; all 55 recipients (100%) responded to the second. Respondents recognized the importance of osteoporosis care, the inadequacy of current measures, and the potential of orthopedic surgeons to help address this gap.”

“Respondents reported regular encounters with fragility fracture patients but limited familiarity with core aspects of osteoporosis screening and treatment, especially pharmacotherapy. While some respondents (40%) reported willingness to attempt a protocol-based approach to addressing this care gap, many others expressed reservations (60%) and support for a FLS [fracture liaison service]-based approach was much higher (95%).”

“We found the orthopaedic surgeons we surveyed were willing to play an increased role in detection and referral of fragility fracture patients but were generally not comfortable with the pharmacological aspects of osteoporosis management. They were therefore mixed in their support for a protocol-based approach to this treatment gap, which would have required them to play an active role in treatment. In contrast, they overwhelmingly supported the implementation of a FLS, where a dedicated ACP [advanced care provider] takes on the pharmacological management.”

“Our work shows that the FLS model fits well with the expressed preferences of orthopaedic surgeons to improve patient care surrounding fragility fractures through identifying patients at risk of future fractures while delegating the treatment of the underlying osteoporosis to a conveniently located non-orthopaedist. We recommend this treatment model to any orthopaedic group able to implement it. When considering doing so, it is important to keep in mind that FLS visits are billed separately from orthopaedic follow up visits and this are economically self-sustaining.”

“The osteoporosis treatment gap after fractures is so large that it is important for orthopaedic surgeons to play an active role in identifying patients at risk for future fractures and referring them for a thorough bone health evaluation and possible osteoporosis treatment.”