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Pins and Plaster Aren’t Enough: A Call for the Evaluation and Treatment of Patients with Osteoporotic Fractures

Department of Medicine (E.S.S., J.P.B., M.R.R.), College of Physicians and Surgeons of Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (D.M.B.), University of California–San Francisco, San Francisco, California 94105; Department of Medicine (R.S.B.), Weill-Cornell Medical College, New York, New York 10021; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; Department of Medicine (M.C.H.), University of Maryland School of Medicine, Baltimore, Maryland 21201; Oregon Osteoporosis Center (M.R.M.), Portland, Oregon 97218; and Department of Medicine (T.J.S.), Northwestern University Medical School, Chicago, Illinois 60611

Address all correspondence and requests for reprints to: Ethel Siris, M.D., Department of Medicine, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, HP 9-964, New York, New York 10032. E-mail: es27{at}columbia.edu.

A history of an osteoporotic fracture is a powerful predictor of future fractures. Older patients who sustain low trauma fractures are candidates for interventions that should include confirmation of the diagnosis of osteoporosis, adequate calcium and vitamin D administration, and use of an osteoporosis therapy that is proven to lower fracture risk. Recently, however, several reports in the literature have indicated that, in general, those physicians who diagnose and treat fractures, i.e. radiologists, orthopedic surgeons, physiatrists, and those who provide general medical care to these fracture patients, the primary care physicians, are not evaluating patients with acute fractures for the presence of osteoporosis and are not prescribing calcium, vitamin D, or specific pharmacological therapy to reduce future fracture risk. These reports suggest that implementation of a standard of care for the subsequent medical management of the older patient with an acute fracture is needed urgently. Diagnostic tools and several effective therapies exist, but these are underused by the physicians who interface with these patients. A call to action is necessary to reduce the human and economic costs associated with this serious and treatable disease.

Abbreviations: BMD, Bone mineral density; NOF, National Osteoporosis Foundation.

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