AOA initiative guides physicians, hospitals in bone health education and treatment

The Own the Bone initiative, launched June 2009, brings providers together to impact patient health.

The American Orthopaedic Association has developed a multidisciplinary, Web-based quality improvement initiative to guide hospitals and practitioners in addressing bone health and fragility fractures.

The evidence-based Own the Bone initiative offers a registry and has testing, counseling, treatment, education and communication components.

According to its organizers, the Own the Bone program, which launched in June 2009, is steadily gaining momentum. However, patients at risk of fragility fractures can only benefit from the initiative when a local site, such as a physician, hospital or health care system, enrolls in the program.

“We want to close this treatment gap that one in five Americans get appropriate evaluation and treatment for their bone health,” Douglas R. Dirschl, MD, chairman of the University of North Carolina’s Department of Orthopedics, said during a Dec. 8 Own the Bone Webinar. “That is simply not acceptable. We want to begin to close that gap with a national program,” he said.

Offers guidelines

During the online roundtable discussion in which Dirschl and other bone health experts participated, he described measures included in the initiative, such as vitamin D and calcium intake regimens, weight-bearing exercises, fall prevention, lifestyle changes and FDA-approved pharmacotherapies.

The initiative suggests to practitioners possible approaches for managing patients with low bone mass, but does not recommend they use specific ones, Dirschl noted.

Once sites are enrolled, Own the Bone helps them organize their resources.

Through the initiative’s communication feature, individual sites can run reports to track data and results for patients in its Web-based registry. They can also generate letters for the primary care physician (PCP) and patient regarding an individual’s bone health and the need for possible bone mineral density testing or follow-up.

Combined effort

“What Own the Bone really endeavors to achieve is to bring together, around each of these patients, a community of providers [that] interact to impact that patient’s health, well-being and knowledge of their bone disease,” Dirschl said.

Jay S. Magaziner, PhD, a professor and chair of the Department of Epidemiology and Preventive Medicine in the School of Medicine at the University of Maryland, who also participated in the discussion, said that it is time for the United States to become proactive in addressing the effects poor bone health has on people older than age 50.

“We will see an increase in the number of hip fractures over the next 40 years in both men and women,” he said. “This situation will require various interventions that are strung together in a coordinated and easily navigated way.”

Beatrice J. Edwards, MD, the director of the Bone Health and Osteoporosis Center at Northwestern University in Chicago, who also participated in the discussion, said to expect positive outcomes from the initiative. She noted that the 10-month, 14-hospital Own the Bone U.S. pilot program conducted in 2005 and 2006 demonstrated statistically significant results. Improvement in some bone health-related measures was seen as early as 6 months after evaluation or therapy.

“Even if you only send a PCP a letter, you can see a result,” she said. – by Susan M. Rapp

Reference:

• www.ownthebone.org
• Douglas R. Dirschl, MD, can be reached at the University of North Carolina School of Medicine, 3147 Bioinformatics CB 7055, Department of Orthopaedics, Chapel Hill, NC 27599-7055; 919-966-9072; e-mail: dirschld@med.unc.edu.
• Jay S. Magaziner, PhD, MSHyg, can be reached at the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201; 410-706-3553; e-mail: jmagazin@epi.umaryland.edu.
• Beatrice J. Edwards, MD, can be reached at Northwestern University Feinberg School of Medicine, Department of Medicine and Orthopaedic Surgery, 645 N. Michigan Ave., Suite 630, Chicago, IL 60611; 312-695-4961; e-mail: bje168@northwestern.edu.

The literature has consistently pointed out that an important way to make sure patients with osteoporotic fractures are identified is to implement a system to manage these patients according to set protocols. The Own The Bone program is an excellent way to assure the identification of the fragility fracture patient and improve quality of care in treatment and follow up.

The goal of the system is to make it easy for the health care provider to identify, treat and follow up patients with low-energy fractures. Own The Bone provides resources for tracking patients as well as educational materials to give patients a better understanding of osteoporosis and the need for treatment.

The program will allow an institution to demonstrate a commitment to excellence of care. It can demonstrate this commitment for potential Joint Commission scrutiny or in cases of liability issues. By helping to reduce the incidence of second fractures the program will not only be good medicine, but will be effective in reducing the cost of health care.

– John D. Kaufman, MD
Orthopedics Today Editorial Board Section Editor, Musculoskeletal Oncology & Metabolic Bone Disease