Osteoporosis prevention program effective in reducing hip fracture rates

Issue: January 2010

If U.S. orthopedic surgeons more actively managed patients at risk for osteoporosis, they could lower the national hip fracture rate by 25%, according to investigators who assessed the effectiveness of a Kaiser Permanente osteoporosis prevention program.

“The only thing that prevents us from getting there is our willingness to try,” the study’s lead investigator, Richard M. Dell, MD, told Orthopedics Today.

He urged orthopedic surgeons to learn about screening and treatment for osteoporosis from his study recently published in The Journal of Bone and Joint Surgery and other resources.

Prevention program

Richard M. Dell, MD
Richard M. Dell

In their prospective, observational study, Dell and colleagues identified a 38% drop in the hip fracture rate among 650,000 men and women older than 50 years enrolled from 2002 to 2007 in the Kaiser Permanente Southern California Healthy Bones program, an osteoporosis prevention effort. This resulted in the prevention of 970 hip fractures in 2007, according to a press release from Kaiser Permanente.

“The most important thing an orthopedic surgeon should know about osteoporosis/fracture prevention is that we can take action that helps to prevent hip and other fragility fractures,” Dell stated in the release.

Take action

“Simple steps, like suggesting calcium and vitamin D for all your patients and bone mineral density testing in patients at higher risk for osteoporosis, should be considered part of your daily practice.”

DXA scans men and women per year
The annual rate at which men and women at centers in the 12 Southern California Kaiser Permanente regions used anti-osteoporosis medications between 2002 to 2008 is shown. During that time, total medication use rates increased overall from about 33,000 to 95,000 individuals.

Source: Kaiser Permanente

Compared with a 20% rate of post-fragility fracture treatment nationally, “Treatment after a fragility fracture at Kaiser Permanente in Southern California is now 68%,” Dell stated in the release. “Health care would be dramatically improved if this model of osteoporosis care were adapted for the rest of America.”

Utilization of osteoporosis-related screenings and medications increased dramatically during the study period. Researchers identified a 263% increase in bone density screening rates in individuals studied, with 78,262 bone density scans done in 2007 compared with 21,557 scans in 2002.

Use of anti-osteoporosis medication among the study population increased 153%.

Anti-osteoporosis treatment men and women
The annual number of dual X-ray absorptiometry scans in the study population increased between 2002 and 2008. In women, the increase was from 20,000 scans in 2002 to more than 150,000 scans in 2008.

“Within a few years, most of our medical centers were able to see a 20% to 30% reduction in the hip fracture rate,” Dell told Orthopedics Today. “I strongly believe it is possible to see similar reductions in hip fracture rates in the United States if widespread adoption of osteoporosis disease-management programs is implemented.”

For more information:
Richard M. Dell, MD, can be reached in the Department of Orthopedics, Kaiser Permanente Downey Medical Center, 9353 E. Imperial Highway, Downey, CA 90242; 562-657-4125; e-mail: Richard.M.Dell@kp.org. He has no direct financial interest in any products or companies mentioned in this article.

Reference:

Dell RM, Greene D, Anderson D, Williams K. Osteoporosis disease management: What every orthopaedic surgeon should know. J Bone Joint Surg (Am). 2009;91:79-86.