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Bone health program informs orthopedic spine surgeons, neurosurgeons

The Own the Bone program provides education and outreach for osteoporotic patients and seeks to help them receive proper care after a fragility fracture.

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The Own the Bone program of the American Orthopaedic Association urges orthopedic surgeons and other health care professionals to begin thinking more about bone health. It was launched in 2009 to address the historic problem of patients who sustained fractures because primary care physicians typically did not take into account metabolic bone disease and bone health.

The Own the Bone Program was designed to help patients receive the proper care and treatment after a fragility fracture, according to Paul A. Anderson, MD, a member of the Own the Bone steering committee. The program has been implemented at 176 sites in 48 states.

Paul A. Anderson

“We as orthopedic surgeons need to take ownership of the bone. That is how Own the Bone started. It was really because of the failure of the delivery system at the time. Frankly, it has not changed very much. Even at the University of Wisconsin, our numbers were pretty stark. Only about 15% of patients, where we are controlling their health care, are given the appropriate diagnostic help after a fracture,” Anderson told Spine Surgery Today.

Osteoporosis may go undetected

In terms of hip fractures on a national basis, as few as 25% of patients who present with such a fracture receive further diagnostic testing or treatment of metabolic bone disease, according to Anderson.

From 2005 to 2008 the geriatric population increased by 6% and fractures increased 21% during that time, he noted.

The goal of Own the Bone is to educate surgeons on how to become more involved in the treatment of metabolic bone disease and to offer the proper care after a fracture for patients worldwide.

Pilot program for fall prevention

A pilot program was conducted at 14 institutions from November 2005 to September 2006, Kyle J. Jeray, MD, chair of the Own the Bone steering committee, said.

Kyle J. Jeray

“The pilot design included multiple quality measures, which were discussed with our patients: recommendations for calcium and vitamin D supplementation, exercise, fall prevention, smoking cessation, bone density testing, pharmacotherapy for osteoporosis and communication with primary care physicians (via mailed letters) recommending further follow-up and evaluation for treatment. Over the course of the pilot project, an increase in eight of the nine bone health recommendations was noted,” Jeray, an orthopedic surgeon, told Spine Surgery Today.

Vertebral fracture incidence

A national database was established by the program, which contains data for more than 23,000 patients with a fragility fracture. About 10% of the fractures reported by participating sites are vertebral fractures. Within the database is information that monitors each individual’s care and progress, as well as each individual Own the Bone site’s compliance with program metrics, Anderson said.

The main benefit of the program is education, outreach and the implementation of care for osteoporotic patients, he said.

“The other part of the Own the Bone program, which has really been the implementation or delivery of the care, is through socalled secondary fracture prevention services or fracture liaison services. These are typically run by physician assistants or nurse practitioners, much like diabetic education. They review a patient’s medical history, do reviews one-on-one, look for secondary causes of osteoporosis in patients and then prescribe treatments using the medical evidence,” Anderson said.

Fragility fractures need attention

A fragility fracture, such as a vertebral compression fracture or hip fracture, seldom triggers osteoporosis assessment and treatment. In the United States, only one of every five participants receives appropriate care after the sentinel event, according to Jeray.

“A huge factor contributing to this problem is a lack of awareness of the need for improvement of skeletal health among health care professionals and our patients. Without treatment for underlying osteoporosis, patients with fragility fractures often experience additional fragility fractures, resulting in additional morbidity, disability and mortality,” he said.

Anderson urged health care organizations that are interested in joining the program to visit the Own the Bone website for additional information. The program is available to any health care organization, not just level-1 trauma centers, and the per-institution annual cost to participate is $2,000 or less, he said. – by Robert Linnehan