Multidisciplinary team supports patients at greater risk of fragility fractures

Bone health is top of mind for many during Osteoporosis Awareness and Prevention Month. This is especially true for the 44 million Americans who have low bone density, placing them at an increased risk for broken bones.

One of the more common types of broken bones patients with low bone density experience are fragility fractures, which are fractures resulting from a fall from standing height or less.

“Fragility fractures, which most commonly occur at the hip, spine, or wrist, are an indication that the body’s bones have been weakened by an underlying condition,” explained Hai Le, assistant professor of orthopaedic surgery. “Therefore, the patient at the highest risk of a fragility fracture is someone who has just had one.”

A recent study conducted by Le and his team found that patients who have had a fragility fracture are more likely to experience another one in the future. It also highlighted the lack of follow-up care to prevent these patients from potentially suffering another fragility fracture. The researchers suggested cases of osteoporosis should be treated earlier on in the medical process.

A multidisciplinary approach to fragility fractures

“When a patient experiences a fragility fracture that requires surgery it is our job to get those patients back on their feet, but we are not the experts when it comes to preventing the next fracture,” said Le. “That's when we bring in our colleagues from endocrinology and rheumatology, who are the experts in diagnosing and treating osteoporosis or other illnesses related to low bone density.”

To support these patients, a multidisciplinary collaboration among UC Davis Health's departments of orthopedic surgery, endocrinology, rheumatology and geriatric care have formed a Fragility Fracture Program. The goal is to ensure that patients who suffer a fragility fracture receive comprehensive treatment to prevent future fractures. They’ll also identify patients who might be at risk for future fractures.

According to the National Osteoporosis Foundation, roughly half of all women and up to one-quarter of all men will suffer a fragility fracture in their lifetime. People who have had a previous fragility fracture are twice as likely to suffer a fracture in the future. Especially in patients over 65, fragility fractures can lead to increased risk of mental and physical problems and a significant decrease in mobility and quality of life. Some fragility fractures can have a mortality rate as high as 33% within the first year.

Diagnosing and treating osteoporosis early

“My role in diagnosing osteoporosis includes conducting a complete laboratory screening of potential risk factors from a hormonal standpoint,” explained Polly Teng, assistant professor of endocrinology and orthopaedic surgery.

Some of the laboratory tests include a patient’s vitamin D, calcium, and parathyroid and thyroid hormone levels, all of which can affect bone fragility. Other tests might be ordered as well, based on each individual patient’s needs.

“These treatments can help manage the underlying causes of a patient’s bone fragility, improve bone stability, and prevent future fractures,” said Barton L. Wise, associate professor of rheumatology and orthopaedic surgery. “There are many good medications to treat illnesses that effect bone density and diagnosing our patients properly allows us to identify the best care plan for each patient, and also evaluate if they have any other underlying disorders.”

Patients also receive visits from nutritionists who provide dietary guidance, and physical therapists who lead them through exercises to strengthen supporting muscles and improve balance and mobility to address fall risks.

Improving mobility to prevent falls

Upon discharge, patients 65 and older who have been hospitalized for a fragility fracture are referred to UC Davis Health's new mobility program at the Healthy Aging Clinic. This one-stop clinic serves patients and their caregivers, allowing them to leverage integrated specialty clinical care and services that can lead to better quality of life and facilitate independent living.

“We take a geriatric approach with our mobility clinic,” said Alia Tuqan, who is a board-certified geriatrician and interim medical director of the clinic. “We start with a physical exam to assess their risks for an additional fall, then work with the patient and any caregivers to formulate a plan to prevent another fall.”

The mobility program is run by clinic nurse practitioners. During the exams, they evaluate a patient's vision, neuropathy, orthostatics, cognitive impairment and any medicines that could increase the patient’s risk of falling.

“We really are focused on providing patient centered care,” Tuqan said. “When it comes to mobility and fall prevention you can't focus on one particular problem, we're focused on helping the patient live their best life possible so that they can be as functional and happy as possible.”

Increased preventive treatment programs like UC Davis Health’s Fragility Fracture Program could have a major impact on public health in the United States and the high costs associated with it. The National Osteoporosis Foundation reported that approximately 1.8 million Medicare beneficiaries suffered approximately 2.1 million osteoporotic fractures in 2016.

“If we could reduce secondary fracture development by just 20%, we could potentially save Medicare over one billion dollars annually,” Le said. “Comprehensive fracture programs could improve patient outcomes, and also provide our Medicare system additional resources to support other programs.”