Orthopaedic clinics offer early osteoporosis diagnostics and fracture prevention

Issue: July 2019

It is common for orthopaedic surgeons to encounter patients with low-energy fractures. This has led to increasing interest in prevention of secondary fractures among orthopaedic surgeons. Hip fractures are the most serious outcome of osteoporosis and increase the mortality and morbidity among older patients. An evidence-based method is available that estimates bone mineral density at the hip, providing vital, early information on the patient’s bone density.

Osteoporosis is characterized by decreased bone mass and deteriorated bone structure which subsequently leads to increased bone fragility and fracture risk. It typically detected as low bone mineral density (BMD). Detecting low bone density is an important determinant of hip fracture as one standard deviation decrease in femoral bone density increases the fracture risk by a factor of two to three. Patients with a fragility fracture are almost twice as likely to suffer another fragility fracture compared to their age-matched peers with no previous fractures. Hip fracture is the most serious outcome of osteoporosis when considering mortality and morbidity. During the first year after a hip fracture, more than 24% of the patients aged 65 years or older will die. Approximately 50% of patients who have suffered a hip fracture had a previous fragility fracture. A large study in Spain showed 18% of patients with a hip fracture had received treatment for osteoporosis and 26% were receiving pharmacological treatment after being discharged from the hospital.

Orthopaedic surgeons routinely encounter patients with low energy fractures, which has led to more interest in the prevention of secondary fractures among orthopaedists. From 2016 to 2019, an EU funded project in the Baltic Sea Region aimed to address the challenges related to fractures and the health disorders linked to them. Due to an ageing society, those challenges are increasing. Over the course of the project, the Tartu University Hospital in Estonia and their Department of Traumatology and Orthopedics participated in a pilot to increase the diagnostics of hip fracture patients.

In the pilot study, a mobile diagnostic device Bindex (Bone Index Finland Ltd.) was used. Bindex estimates the BMD at the hip and provides 90% sensitivity and specificity compared to DXA-based osteoporosis diagnostics. Use of this method enables osteoporosis diagnostics to take place at the patient’s bedside in the hospital ward and the method could potentially also be used prior to surgery. In the short pilot study, 26 patients were measured and Bindex showed 100% sensitivity and 80% specificity when compared to DXA diagnostics at the hip. Considering the International Society for Clinical Densitometry (ISCD) and National Osteoporosis Society (NOS) guidelines, one could already initiate treatment for those with low bone density measured with Bindex.

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“This will make the diagnostics effective while treating for fractures at orthopaedic clinics. We can target the DXA resources for those who need it if baseline measurements are required for treatment follow-up,” Aare Märtson, MD, PhD, from the department of traumatology and orthopaedics, Tartu University Hospital, said.

The Bindex method also has been studied for its cost-effectiveness in a Finnish fracture management pathway. When applied to patients with an elevated fracture risk, Bindex diagnostics for osteoporosis has been shown to be cost-saving and effective with about 122 euros saved per patient. The approach has been adopted in the Kuopio University Hospital department of orthopedics and traumatology and nearby primary care units that are responsible for the care of patients after fracture treatment. When the bone density scan is available for all fracture patients, it helps both the physicians and patients initiate and commit to required treatment or further diagnostics.

This approach could be the answer for diagnostics and treatment gaps in orthopaedic clinics, but also in other units that participate to the care of fracture patients. An interesting application would be the use of Bindex before surgical treatment of fractures. The information on bone condition could help surgeons in the selection on which instruments or implants they use, and this could have further impact on patient recovery or complications.

“Bindex is an evidence-based method, with approximately 2,500 patients studied in controlled clinical trials and reported in several high-class peer reviewed publications. Right now, it is an essential part of secondary fracture prevention at Kuopio University Hospital District,” Heikki Kröger, MD, PhD, from the department of orthopedics and traumatology at Kuopio University Hospital, said.

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For more information:
Janne Karjalainen, PhD, is executive vice president at Bone Index Finland Ltd. He can be reached at Savilahdentie 14, 70700 Kuopio, Finland; email: janne.karjalainen@boneindex.fi.
Heikki Kröger, MD, PhD, is chief orthopaedic surgeon. He can be reached at department of orthopaedics, traumatology and hand surgery, Kuopio University Hospital, 70029 Kuopio, Finland; email: heikki.kroger@kuh.fi.