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Gap in surgeon knowledge of osteoporosis treatment uncovered in survey
Inadequate training, evaluation and treatment cited in call for more educational opportunities.
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A survey of 3422 orthopaedic surgeons in five European countries and New Zealand found half the respondents reporting they received little or no training in how to treat osteoporosis. Another 40% reported only “moderate” training.
The key implication: Most patients presenting fragility fractures in those regions get discharged “without adequate evaluation of osteoporosis,” said Karsten E. Dreinhofer, MD, of Germany, who led the study sponsored by the Bone and Joint Decade (BJD) and the International Osteoporosis Foundation (IOF).
Osteoporosis involves a decrease in bone mass and a related rise in fracture risk, especially in postmenopausal women, individuals on long-term corticosteroid therapy and the elderly. Because patients presenting their first fragility fracture face higher risks for future fractures, and because orthopaedic surgeons “are not well attuned to osteoporosis,” the BJD and IOF decided to measure surgeon preparedness to create a knowledge base. The five European countries covered included France, Germany, Italy, Spain and the United Kingdom.
Few bone density tests orders
The respondents, who included 25% of all orthopaedic surgeons in the region surveyed, reported treating five to 10 patients per month for osteoporosis. When asked, “What do you do after you treat a person for osteoporosis, or see a fragility fracture – do you refer for a bone density test?” Dreinhofer said, paraphrasing a survey question, only 10% to 15% of respondents reported doing so. Twenty percent said they never did. Dreinhofer presented the study results study at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting.
Additional key findings included the following:
- Just one out of four orthopaedic surgeons in France, the UK and New Zealand reported feeling knowledgeable about managing osteoporosis.
- Only about half of the surgeons in southern Europe know about the importance of some external risk factors for hip fractures such as cataracts, poor lighting, pathway obstacles and poor balance.
- Less than half of the surgeons in France, the UK and New Zealand prescribe calcium and vitamin D.
Education can fix it
“Fractures are common,” Dreinhofer noted. “The number of hip fractures is expected to increase. Yet the majority of patients are discharged without adequate evaluation of osteoporosis.”
The solution? “The responsibility so far was to fix it [a fracture],” Dreinhofer said in his presentation. “We believe it is also to inform the patient of the need for an osteoporosis evaluation, to investigate whether osteoporosis is the underlying cause of the fracture and to ensure that a proper intervention is initiated.”
“Education and knowledge needs to be improved, and more educational opportunities need to be offered to orthopaedic surgeons,” Dreinhofer said.
For more information:
- Dreinhofer K, Lidgren L, Wallace WA, et al. Multinational survey of osteoporotic fracture management. Presented at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting. Feb. 23-27, 2005. Washington.