An estimated 1.5 million people experience a fracture from falling each year, and only 20 percent of them receive follow-up treatment for osteoporosis.
“That’s ridiculous. That’s unbelievably low,” said Dr. Richard Dell, an orthopedic surgeon at Kaiser Permanente in Downey, Calif.
Dell said the problem is that there’s little preventive care for bone health. He said too many orthopedists focus on fixing the fractures, then leave the necessary follow-up care to someone else.
“That’s not good enough,” Dell said.
In 1998, Dell launched a healthy bones program at his hospital in Bellflower, Calif. The program brought together a number of health professionals, such as internists, orthopedists, radiologists and endocrinologists, who were interested in osteoporosis. As a team, they set out to decrease the number of hip fractures.
They were going to do this by identifying people at risk for osteoporosis, getting them a bone density test and any necessary treatment such as medicines and/or physical therapy. With an electronic medical records system, such patients would be easier to track.
For patients who sustained a fracture, they would provide follow-up care.
The results were better than they expected.
“We actually were able to decrease our hip fracture rate by almost 40 percent, and this was over a two-year period,” Dell said.
So, Dell decided to expand it to 10 other hospitals in Kaiser Southern California, a health-maintenance organization with 3.2 million members. The hip fracture rate was reduced 38 percent. That translated to the prevention of 970 hip fractures in 2007.
“You have to develop a systems approach so that the care gap is eliminated, and that’s what we are doing,” Dell said. “You can’t just ask the primary care doctors to do this.”
Lawrence stepping up
Dr. Doug Stull, an orthopedic surgeon at OrthoKansas in Lawrence, sees the need for such a program in Lawrence because he believes patients are falling through the cracks.
“We frequently forget after we fix the fracture, ‘Well, how does the bone heal and what do we do to prevent future fractures?’” he said.
He said preventing fractures is important given the alarming outlook for individuals who experience, for example, a hip fracture:
• 20 percent may require long-term nursing home care.
• 50 percent never regain their ability to walk independently.
• 20 percent die within one year because of complications from the fracture or surgery.
• 33 percent become totally dependent.
ON THE TEAM
Here are the members of the Lawrence Healthy Bones Team:
Dr. Doug Stull, orthopedic surgeon; Dr. Marc Scarbrough, hospitalist; Dr. Sherri Vaughn, primary care physician; Dr. Anne Van Garsse, pediatrician; Dr. Sherri Quick, physical medicine and rehabilitation; Karen Shumate, Lawrence Memorial Hospital vice president of clinical services; Stephanie Porto, pharmacist; Jaye Cole, director of Kreider Physical Therapy and Rehabilitation; Shelley Terrell, LMH director of post surgical unit; Linda Gall, LMH director of case management; Ramona Hamilton, registered nurse.
If you would like more information about the Healthy Bones Team, call 505-6373.
In August, Stull spearheaded the new 11-member Healthy Bones Team, which is dedicated to increasing community awareness about bone health and assisting physicians in the fight against osteoporosis. Among the team’s members are a hospitalist, pediatrician, occupational therapist and pharmacist.
“I think we’ve made progress in setting up a system that will at least be a pathway. So when someone comes to LMH with a hip fracture, at least hopefully, they won’t slip through the cracks,” Stull said.
Tracking patients who might need a bone density test won’t be as easy as it was for Kaiser because that is a closed medical community that shares medical records electronically.
“It’s going to be more difficult to coordinate this amongst the medical community of independent practitioners,” Stull said. “It’s going to be hard. But, it’s a big rock and you’ve got to keep pushing it to make it move.”
Besides providing better care for the aging population, the Lawrence team wants to improve bone health in younger people.
“I want my daughters when they get to be teenagers to understand that this is when their bones need the most attention to reach their optimal bone density, and if they drink Coke and eat Cheetos and McDonald’s, that’s not going to happen,” Stull said.
Calcium requirements are greatest between the ages of 9 and 18 at 1,300 milligrams per day. Adults should be getting 1,000 milligrams per day and those older than 50 need 1,200 milligrams.
Shelley Terrell, director of the post-surgical unit at LMH, also is a member of the team. She said parents should encourage their children, especially girls, to eat calcium-rich foods.
Research shows 50 percent of all women and one-third of men will sustain a fragility fracture in their lifetime.
“Teenage girls are one of the target populations that you really want to encourage because they don’t drink as much milk a lot of times,” Terrell said.
Calcium-packed foods include skinny lattes, almonds, low-fat cheese cubes, pudding with skim milk or a calcium-fortified cereal bar.
“I am excited to be part of anything that can improve the health of the community, and I think this can have a huge impact, Terrell said.
Dr. Dell, of Kaiser, will be in Lawrence on Thursday to talk with the medical community and then give a public presentation. He believes the Healthy Bones team will make a difference.
“You probably can see a 25 percent reduction in the hip fracture rate probably within two years, and you may see a 40 percent reduction over the course of four years after a program like this is in place,” Dell said. “So, don’t be surprised in Kansas if you see a heck of a lot less hip fractures.”