Barriers and Solutions to Osteoporosis Care in Patients with a Hip Fracture

As the population ages, orthopaedic surgeons are treating an escalating number of patients who have a hip fracture. The total number of hip fractures worldwide was estimated to be 1.7 million in 1990 and is projected to climb to 6.3 million in 2050 1,2. The number of men and women with disabilities directly related to these fractures is reaching epidemic proportions. Even small increases in lifespan will lead to large increases in the rate of hip fracture because the risk of hip fracture increases exponentially with age 3. Approximately 50% of women who sustain a hip fracture lose the ability to walk normally, and complications directly related to the fracture cause a 20% increase in mortality during the six months after the fracture 4-7. In the United States, substantial resources are needed for both acute and long-term treatment of hip fractures. It has been estimated that these costs range from seven to ten billion dollars annually 8. Osteoporosis is the major cause of hip fractures in older adults. Although there are pharmacologic agents available to both prevent and treat osteoporosis, the identification of the appropriate population to target for therapy remains elusive. One of the major problems in averting rapidly increasing numbers of hip fractures has been the underrecognition of osteoporosis by physicians. One recent study revealed that only 5% of patients with osteoporosis or multiple risk factors for it were properly diagnosed and treated for the condition, 12% had signs and symptoms but were undiagnosed, and 5% were diagnosed but not treated 9. The remaining 78% of the patients were neither diagnosed nor treated. In 2000, a retrospective cohort study of 1162 postmenopausal women with a distal radial fracture found that only 2.8% underwent bone-mineral-density testing and only 22.9% received …